title: Comparative outcomes of open versus laparoscopic sacrocolpopexy among Medicare beneficiaries.
abstract: OBJECTIVE
  Since the first reported laparoscopic sacrocolpopexy in 1991, a limited number of single-center studies have attempted to assess the procedure's effectiveness and safety. Therefore, we analyzed a national Medicare database to compare real-world short-term outcomes of open and laparoscopically assisted (including robotic) sacrocolpopexy in a United States sample of patients.
  
  
  METHODS
  Public Use File data for a 5% random national sample of all Medicare beneficiaries aged 65 and older were obtained from the Centers for Medicare and Medicaid Services for the years 2004-2008. Women with pelvic organ prolapse were identified using ICD-9 diagnosis codes. CPT-4 procedure codes were used to identify women who underwent open (code 57280) or laparoscopic (code 57425) sacrocolpopexy. Individual subjects were followed for 1 year post-operatively. Outcomes measured, using ICD-9 and CPT-4 codes, included medical and surgical complications and re-operation rates.
  
  
  RESULTS
  Seven hundred and ninety-four women underwent open and 176 underwent laparoscopic (including robotic) sacrocolpopexy. Laparoscopic sacrocolpopexy was associated with a significantly increased rate of re-operation for anterior vaginal wall prolapse (3.4% vs 1.0%, p = 0.018). However, more medical (primarily cardiopulmonary) complications occurred post-operatively in the open group (31.5% vs 22.7%, p = 0.023). When sacrocolpopexy was performed with concomitant hysterectomy, mesh-related complications were significantly higher in the laparoscopic group (5.4% vs 0%, p = 0.026).
  
  
  CONCLUSIONS
  Laparoscopic sacrocolpopexy resulted in an increased rate of reoperation for prolapse in the anterior compartment. When hysterectomy was performed at the time of sacrocolpopexy, the laparoscopic approach was associated with an increased risk of mesh-related complications.
authors: Department of Urology, UCLA, Los Angeles, CA, USA.
authors: Aqsa
authors: A
authors: Khan
authors: Marianna
authors: M
authors: Alperin
authors: Ning
authors: N
authors: Wu
authors: J Quentin
authors: JQ
authors: Clemens
authors: Emily
authors: E
authors: Dubina
authors: Chris L
authors: CL
authors: Pashos
authors: Jennifer T
authors: JT
authors: Anger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy; D006278:Medicare; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
references: Am J Obstet Gynecol. 1996 Dec;175(6):1418-21; discussion 1421-2
references: 8987919
references: Obstet Gynecol. 2011 Nov;118(5):1005-1013
references: 21979458
references: Cochrane Database Syst Rev. 2010 Apr 14;(4):CD004014
references: 20393938
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: BJOG. 2005 Aug;112(8):1134-8
references: 16045530
references: J Urol. 2006 Aug;176(2):655-9
references: 16813916
references: Am J Obstet Gynecol. 2011 Apr;204(4):360.e1-7
references: 21306698
references: Obstet Gynecol. 2007 Mar;109(3):707-14
references: 17329524
references: Obstet Gynecol. 2004 Oct;104(4):805-23
references: 15458906
references: Int Urogynecol J. 2013 Mar;24(3):377-84
references: 22864764
references: N Engl J Med. 2006 Apr 13;354(15):1557-66
references: 16611949
references: J Minim Invasive Gynecol. 2005 May-Jun;12(3):221-6
references: 15922979
references: J Endourol. 2007 Aug;21(8):926-30
references: 17867956
references: J Urol. 2007 Oct;178(4 Pt 1):1411-7
references: 17706713
references: N Engl J Med. 2010 Aug 19;363(8):701-4
references: 20818872
references: Int Urogynecol J. 2011 Feb;22(2):205-12
references: 20842494