Trends in Mesh Use for Pelvic Organ Prolapse Repair From the Medicare Database.
OBJECTIVE
To investigate recent trends in mesh use for pelvic organ prolapse (POP)-related reconstruction procedures.


METHODS
Using the 2001-2011 5% Medicare claims database, we identified POP diagnoses and related procedures. Transvaginal mesh use and sacrocolpopexy were first reported in 2005 and 2004, respectively.


RESULTS
A total of 613,160 cases of vaginal and abdominal POP repair procedures were identified. The majority of procedures involved multiple compartments. The rate of mesh use increased dramatically from 2% of repairs in 2005 to 35% by 2008. After the Food and Drug Administration warning in 2008, mesh use plateaued and then decreased in 2011. Mesh was used more commonly in younger (odds ratio [OR] 0.722, P < .001), white (OR 0.712-0.791 for other races, P < .001) women in the South (OR 0.741-0.848 for non-South regions, P < .001). Starting in 2008, the rate of sacrocolpopexy procedures almost doubled yearly until 2011. Sacrocolpopexy was more common in younger patients (49% in women <70 years) and in white women (88%); the majority of sacrocolpopexies were performed in the South (60%) and laparoscopically (83%-98%).


CONCLUSIONS
The treatment of POP has changed over time. The use of mesh increased significantly until 2008, after which it plateaued following the Food and Drug Administration warning regarding mesh-related complications. Concurrently, the number of sacrocolpopexy procedures increased significantly starting in 2008 as the use of laparoscopic and/or robotic technique and concern regarding transvaginal mesh increased.
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Lily C
LC
Wang
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Bashir
B
Al Hussein Al Awamlh
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Jim C
JC
Hu
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Melissa A
MA
Laudano
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Wesley L
WL
Davison
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Michael L
ML
Schulster
Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
Fujun
F
Zhao
Department of Urology, Weill Medical College of Cornell University, New York, NY.
Bilal
B
Chughtai
Department of Urology, Weill Medical College of Cornell University, New York, NY. Electronic address: ril9010@med.cornell.edu.
Richard K
RK
Lee
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome; D014481:United States