title: Practice patterns of general gynecologic surgeons versus gynecologic subspecialists for concomitant apical suspension during vaginal hysterectomy for uterovaginal prolapse.
abstract: OBJECTIVE
  We hypothesized that subspecialists perform more concomitant apical suspensions during transvaginal hysterectomy for uterovaginal prolapse as compared with general gynecologists.
  
  
  METHODS
  Retrospective analysis of the MedStar Health EXPLORYS database for women undergoing transvaginal hysterectomy for prolapse. Appropriate International Classification of Diseases-9 codes for uterine prolapse and incomplete and complete uterovaginal prolapse along with Current Procedural Terminology codes were used to determine frequency of transvaginal hysterectomy alone, transvaginal hysterectomy plus nonapical repair, and transvaginal hysterectomy plus concomitant apical suspension.
  
  
  RESULTS
  A total of 946 patients underwent vaginal hysterectomy for prolapse, with 5.5 years follow-up. Thirty-five percent (n = 334) underwent transvaginal hysterectomy alone, 20% (n = 184) underwent transvaginal hysterectomy plus nonapical repair, and 45% (n = 428) underwent transvaginal hysterectomy plus apical suspension. Seventy-two percent of patients operated on by general gynecologists compared with 4% of patients operated on by urogynecologists had a transvaginal hysterectomy alone. Only 10% of patients operated on by general gynecologic surgeons compared with 78% operated on by urogynecologists received a concomitant apical suspension for prolapse (P < 0.0001). Forty-four patients (4.7%) required repeat surgery for recurrent prolapse. Because of the small number of repeat surgeries, preoperative degree of prolapse and type of index procedure did not significantly affect the need for repeat surgery.
  
  
  CONCLUSIONS
  The majority of prolapse procedures involving hysterectomies performed by general gynecologists do not include apical suspension, whereas urogynecologic subspecialists consistently perform apical suspension.
authors.affiliation: From the Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, and the Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland.
authors.forename: Ladin A
authors.initials: LA
authors.lastname: Yurteri-Kaplan
authors.affiliation: From the Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, and the Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland.
authors.forename: Mihriye M
authors.initials: MM
authors.lastname: Mete
authors.affiliation: From the Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, and the Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland.
authors.forename: Chris
authors.initials: C
authors.lastname: St Clair
authors.affiliation: From the Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, and the Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland.
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014596:Uterine Prolapse / Q000601:surgery*