title: Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse.
abstract: BACKGROUND
  It has been shown that addressing apical support at the time of hysterectomy for pelvic organ prolapse (POP) reduces recurrence and reoperation rates. In fact, national guidelines consider hysterectomy alone to be inadequate treatment for POP. Despite this, anterior and posterior colporrhaphy are frequently performed without a colpopexy procedure and hysterectomy alone is often utilized for treatment of prolapse.
  
  
  OBJECTIVE
  The objectives of this study were to: (1) determine rates of concomitant procedures for POP in hysterectomies performed with POP as an indication, (2) identify factors associated with performance of a colpopexy at the time of hysterectomy for POP, and (3) identify the influence of surgical complexity on perioperative complication rates.
  
  
  METHODS
  This is a retrospective cohort study of hysterectomies performed for POP from Jan. 1, 2013, through May 7, 2014, in a statewide surgical quality database. Patients were stratified based on procedures performed: hysterectomy alone, hysterectomy with colporrhaphy and without apical suspension, and hysterectomy with colpopexy with or without colporrhaphy. Demographics, medical history and intraoperative care, and perioperative care were compared between the groups. Multivariable logistic regression models were created to identify factors independently associated with use of colpopexy and factors associated with increased rates of postoperative complications.
  
  
  RESULTS
  POP was an indication in 1557 hysterectomies. Most hysterectomies were vaginal (59.6%), followed by laparoscopic or robotic (34.1%), and abdominal (6.2%). Hysterectomy alone was performed in 43.1% (95% confidence interval [CI], 40.6-45.6) of cases, 32.8% (95% CI, 30.4-35.1) had a colporrhaphy without colpopexy, and 24.1% (95% CI, 22-26.3) had a colpopexy with or without colporrhaphy. Use of colpopexy was independently associated with patient age >40 years, POP as the only indication for surgery (odd ratio [OR], 1.6; 95% CI, 1.185-2.230), laparoscopic surgery (OR, 3.2; 95% CI, 2.860-5.153), and a surgeon specializing in urogynecology (OR, 8.2; 95% CI, 5.156-12.923). The overall perioperative complication rate was 6.6%, with the majority being considered minor. Complications were more likely when the procedure was performed with an abdominal approach (OR, 2.3; 95% CI, 1.088-4.686), with the use of a colpopexy procedure (OR, 3.1; 95% CI, 1.840-5.194), and by a surgeon specializing in urogynecology (OR, 2.2; 95% CI, 1.144-4.315).
  
  
  CONCLUSIONS
  Colpopexy and colporrhaphy may be underutilized and are potential targets for quality improvement. Performance of additional procedures at the time of hysterectomy increased the rate of perioperative complications. Long-term consequences of these surgical practices deserve additional study.
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, University of Michigan, Ann Arbor, MI. Electronic address: fairchip@med.umich.edu.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Fairchild
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Kamdar
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Berger
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006176:Gynecology; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007348:Insurance, Health / Q000706:statistics & numerical data; D010535:Laparoscopy; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D016015:Logistic Models; D008484:Medicaid; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D056887:Pelvic Organ Prolapse / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications; D011787:Quality of Health Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014481:United States; D014572:Urology; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014596:Uterine Prolapse / Q000453:epidemiology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: apical suspension; colpopexy; colporrhaphy; pelvic organ prolapse; surgical quality measures