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Regional Performance of Apical Support Procedures at Time of Hysterectomy for Benign Indications: What Is the Role of Surgeon Training?
Putman, Jessica G; Meister, Melanie R; Lenger, Stacy M; Lowder, Jerry L.
Afiliação
  • Putman JG; From the Department of Obstetrics and Gynecology, Barnes-Jewish Hospital, Washington University in St. Louis, Saint Louis, MO.
  • Meister MR; Department of Obstetrics and Gynecology, University of Kansas, Kansas City, KS.
  • Lenger SM; Department of Obstetrics and Gynecology, Washington University in St. Louis, Saint Louis, MO.
  • Lowder JL; Department of Obstetrics and Gynecology, Washington University in St. Louis, Saint Louis, MO.
Female Pelvic Med Reconstr Surg ; 27(7): 421-426, 2021 07 01.
Article em En | MEDLINE | ID: mdl-32701766
ABSTRACT

OBJECTIVE:

The objective of this study was to determine factors associated with performance of concomitant apical support procedures (ASPs) with benign hysterectomy at a regional medical system.

METHODS:

Benign hysterectomies performed within 1 regional medical system from January 2011 to November 2017 were identified using International Classification of Diseases, Ninth and 10th Revision, and Current Procedural Terminology codes. Primary outcome was performance of concomitant ASP. χ2 Tests compared categorical variables. Multivariable logistic regression analysis was performed to determine factors associated with performance of concomitant ASP.

RESULTS:

A total of 12,345 benign hysterectomies were performed during the study period. Uterovaginal prolapse was the primary diagnosis in 924 (7.48%) hysterectomies and an associated diagnosis in 1180 (9.56%) hysterectomies. A total of 686 patients (5.56%) had concurrent ASPs 119 (17.3%) in patients without a diagnosis of prolapse and 567 (82.7%) with prolapse. Using multivariable logistic regression, controlling for age, race, insurance type, hospital type, procedure year, hysterectomy route, and surgeon training in patients with a diagnosis of prolapse, older age, supracervical hysterectomy, and surgeon training were associated with performance of ASPs.

CONCLUSIONS:

Even in patients with a preoperative diagnosis of uterovaginal prolapse, ASPs are not routinely performed at time of hysterectomy. Fellowship-trained surgeons were more likely to perform ASPs. Ongoing educational efforts during training and postgraduate at the national and regional level on the importance of reestablishing apical vaginal support at time of hysterectomy is needed to prevent incident and recurrent post-hysterectomy vaginal vault prolapse.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Prolapso Uterino / Histerectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Female Pelvic Med Reconstr Surg Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Macau

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Prolapso Uterino / Histerectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Female Pelvic Med Reconstr Surg Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Macau