title: Role of concurrent vaginal hysterectomy in the outcomes of mesh-based vaginal pelvic organ prolapse surgery.
abstract: OBJECTIVE
  Hysterectomy is often performed at the time of pelvic organ prolapse (POP) surgery; yet, there is insufficient evidence regarding the specific effect of hysterectomy on outcomes. We sought to determine the outcomes and associated short-term complications of mesh-based POP surgery with and without concurrent hysterectomy.
  
  
  METHODS
  We utilized the New York Statewide Planning and Research Cooperation System (SPARCS) database to identify patients under 55 years of age undergoing surgeries for POP with mesh between 2009 and 2014. Patients who had a hysterectomy at the time of mesh-based POP surgery were compared with those who underwent mesh-based POP surgery without hysterectomy. Outcome measures of the patient groups before and after propensity score matching were compared. We assessed the difference Chi-squared tests and log-rank tests in the entire cohort and Mantel-Haenszel stratified Chi-squared tests and Prentice-Wilcoxon tests in the matched cohort.
  
  
  RESULTS
  A total of 1,601 women underwent mesh-based POP surgery. 921 patients underwent concurrent hysterectomy, whereas 680 had mesh-based uterine-preserving POP surgery. After propensity score matching, there was no difference in reintervention rates between groups for up to 3 years. Concurrent hysterectomy with mesh-based POP repair was consistently associated with longer hospitalization (20.0% vs 12.8% stayed longer than 2 days) and higher charges (median charges were $22,689 vs $19,273).
  
  
  CONCLUSIONS
  Concurrent hysterectomy during mesh-based POP surgery in patients under 55 years led to more expensive charges and a longer stay compared with uterine-preserving mesh surgery. There was no difference in reintervention rates between groups for up to 3 years.
authors.affiliation: Beaumont Hospital, Dublin, Ireland, D09 V2N0.
authors.forename: James C
authors.initials: JC
authors.lastname: Forde
authors.affiliation: Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA. bic9008@med.cornell.edu.
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.affiliation: Department of Urologic Reconstruction, Urodynamics, and Female Urology, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009518:New York; D059351:Organ Sparing Treatments / Q000191:economics / Q000379:methods*; D056887:Pelvic Organ Prolapse / Q000191:economics / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery*
keywords: Hysterectomy; Mesh; Pelvic organ prolapse