Concomitant apical prolapse repair and incontinence procedures: trends from 2001-2009 in the United States

Abstract

Objective: Recent evidence supports improved outcomes in women who undergo an incontinence procedure at the time of apical prolapse repair compared with apical repair alone. Our primary objective was to describe national trends in concomitant apical repair and incontinence procedures that were performed in the United States from 2001-2009. A secondary objective was to describe complications and length of stay.

Study design: We used the Nationwide Inpatient Sample to collect data on hospital discharges for women who had inpatient apical prolapse surgery from 2001-2009. We included women whose records included the International Classification of Disease-9 Clinical Modification procedure codes for apical procedures with and without incontinence procedures. We examined annual trends in the proportion of concomitant procedures using chi-square testing and multiple logistic regression.

Results: Of all apical procedures, the percentage of concomitant incontinence procedures performed increased from 37.9% in 2001 to 47% in 2009 (P = .0002 for trend). In-hospital complications (hemorrhage, bowel obstruction, and/or abscess) were less common with concomitant procedures (6.8% vs 11.7%; P = .02). All geographic regions had increasing trends of concomitant incontinence procedures with no difference among regions (P = .7 for interaction). Both community and academic institutions had increasing trends of concomitant procedures over the study period, with no difference among the types of institutions. Age was not associated with increasing trends in concomitant procedures.

Conclusion: The proportion of concomitant apical and incontinence procedures increased in the United States from 2001-2009. Length of stay was slightly longer for the concomitant group, but complications were not increased.

Keywords: incontinence; pelvic organ prolapse; suburethral sling; trends.