title: Patterns of pessary care and outcomes for medicare beneficiaries with pelvic organ prolapse.
abstract: OBJECTIVE
  Using a national data set, we sought to assess patterns of pessary care in older women with pelvic organ prolapse (POP) and subsequent outcomes, including rates of complications and surgical treatment of POP.
  
  
  METHODS
  Public use files from the US Centers for Medicare and Medicaid Services were obtained for a 5% random national sample of beneficiaries from 1999 to 2000. Diagnostic and procedural codes (International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology, 4th Edition) were used to identify women with POP and those treated with pessary. Individual subjects were followed longitudinally for 9 years. Across this duration, patient care and outcomes (eg, return clinic visits, repeated pessary placements, complications, and rate of surgical treatment of prolapse) were assessed.
  
  
  RESULTS
  Of 34,782 women with a condition diagnosed as POP, 4019 women (11.6%) were treated with a pessary. In the initial 3 months after pessary placement, 40% underwent a follow-up visit with the provider who had placed the pessary, and through 9 years after the initial fitting, 69% had such a visit. During this period, 3% of the subjects developed vesicovaginal or rectovaginal fistulas, and 5% had a mechanical genitourinary device complication. Twelve percent of women underwent surgery for POP by 1 year; with 24% by 9 years.
  
  
  CONCLUSIONS
  Pessary can be effectively used for the management of POP in older women. Despite this, a low percentage of Medicare beneficiaries undergo pessary fitting. Lack of continuity of care is associated with a small but unacceptable rate of vaginal fistulas.
authors.affiliation: UCSD Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, San Diego, CA, USA.
authors.forename: Marianna
authors.initials: M
authors.lastname: Alperin
authors.forename: Aqsa
authors.initials: A
authors.lastname: Khan
authors.forename: Emily
authors.initials: E
authors.lastname: Dubina
authors.forename: Christopher
authors.initials: C
authors.lastname: Tarnay
authors.forename: Ning
authors.initials: N
authors.lastname: Wu
authors.forename: Chris L
authors.initials: CL
authors.lastname: Pashos
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006278:Medicare; D056887:Pelvic Organ Prolapse / Q000601:surgery / Q000628:therapy*; D010570:Pessaries / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States