Variation in the quality of surgical care for uterovaginal prolapse

Abstract

Background: Pelvic organ prolapse is a common disorder, affecting an estimated 24% of women in the United States, with more than 200,000 surgical procedures performed annually. Current treatment recommendations from the American College of Obstetricians and Gynecologists include pelvic floor reconstruction (or pexy) procedures to correct prolapse, with or without hysterectomy; however, many women are treated by hysterectomy alone.

Objective: To determine whether hospital characteristics predict compliance with recommended surgical care for uterovaginal prolapse.

Methods: Retrospective analysis of linked California hospital discharge and financial data. International Classification of Diseases, ninth Edition Clinical Modification codes identified records with a primary diagnosis of prolapse and concomitant coding for surgical procedures. χ2 analysis and multivariable models were used to characterize the associations between hospital characteristics and compliance. Compliant care was defined as prolapse treatment by pelvic floor reconstruction (pexy) procedure with or without hysterectomy. Failed compliance was defined as hysterectomy alone.

Results: A total of 28,539 cases in 343 hospitals were analyzed. Low compliance rates were detected in all hospital types, though some were better than others. High-volume (odds ratios [OR] = 1.75; 95% CI: [1.62, 1.89]), teaching (OR = 2.03; 95% CI: [1.84, 2.25]), and private (OR = 1.28; 95% CI: [1.14, 1.46]) hospitals were more likely, while disproportionate share hospitals were less likely (OR = 0.58; 95% CI: [0.54, 0.63]) to comply with evidence-based recommendation.

Conclusion: Although we did find significant variation in compliance by hospital characteristics, compliance rates were low in all settings. Quality improvement efforts in the surgical treatment of uterovaginal prolapse should focus on increasing adherence to evidence-based practice.