title: Apical support at the time of hysterectomy for uterovaginal prolapse.
abstract: OBJECTIVE
  The aim was to determine factors associated with performing concurrent apical support procedures in hysterectomies carried out for uterovaginal prolapse.
  
  
  METHODS
  Hysterectomies performed for uterovaginal prolapse from 2000 to 2010 were identified by ICD-9 codes. Uterovaginal prolapse was a proxy for apical descent. Primary outcome was the rate of concurrent apical procedures. Secondary outcomes included concurrent surgeries, complications, and surgeon training. Chi-squared tests compared categorical variables. Logistic regression determined factors associated with concurrent apical support.
  
  
  RESULTS
  A total of 2,465 hysterectomies were performed for uterovaginal prolapse. In only 1,358 cases (55.1%) were concurrent apical support procedures carried out. Cases without apical procedures were more likely to undergo cystocele repair (23.8% vs 9.4%, p < 0.001), but less likely to have rectocele (3.4% vs 12.2%, p < 0.001) or combined cystocele/rectocele repair (16.4% vs 25.6%, p < 0.001). Of those without apical procedures, 95.7% were performed by generalists. Urogynecologists and minimally invasive gynecologists were more likely to perform apical procedures (97.1% and 88.8% vs 23.6%, p < 0.001). Older patients (>75 years) were more likely to undergo apical procedures (OR 5.096, 95% CI 3.127-8.304). Surgeons practicing for 10-14 years and >20 years were less likely to perform apical procedures than those practicing <5 years (p < 0.001 vs. p = 0.01).
  
  
  CONCLUSIONS
  At a tertiary hospital, a significant proportion of hysterectomies are carried out for uterovaginal prolapse without concurrent apical support procedures, with the majority performed by generalists. Urogynecologists and minimally invasive gynecologists are more likely to perform an apical suspension at the time of hysterectomy for uterovaginal prolapse than generalists. This supports the need for continued education about apical support to appropriately manage uterovaginal prolapse.
authors.affiliation: Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, 15213, USA, kellykantartzis@gmail.com.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Kantartzis
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Turner
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Lowder
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D052858:Cystocele / Q000150:complications / Q000601:surgery; D005260:Female; D013502:General Surgery / Q000193:education / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006176:Gynecology / Q000193:education / Q000706:statistics & numerical data; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D010052:Ovariectomy / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D020047:Rectocele / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D058994:Salpingectomy / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000628:therapy; D014572:Urology / Q000193:education / Q000706:statistics & numerical data; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*; D014621:Vagina / Q000601:surgery*