Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse

Authors

Kristen A. Gerjevic, Department of Obstetrics and Gynecology, the Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice, the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; the Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; and Maine Medical Center, Tufts University School of Medicine, Portland, Maine.
Helen Newton
Christopher Leggett
Jonathan Skinner
Elisabeth Erekson
Kris Strohbehn

Document Type

Article

Publication Date

3-10-2022

Journal Title

Obstetrics and gynecology

Abstract

OBJECTIVE: To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries. METHODS: We conducted a retrospective, cross-sectional study and used 100% Medicare fee-for-service claims to identify a cohort of women aged 65-99 years who had an apical support procedure, defined by Current Procedural Terminology codes, in 2016-2018. We included all vaginal and abdominal approaches (native tissue and mesh colpopexies) and obliterative procedures. We excluded vaginectomies with a diagnosis of gynecologic cancer that did not have a diagnosis for prolapse. We created rates of apical POP procedures by hospital referral region and computed coefficients of variation to measure the degree of geographic variation. RESULTS: An average of 26,005 apical POP procedures were performed annually from 2016 to 2018. The majority of patients were aged 65-74 years (64.3%), and 28.5% had concomitant hysterectomy. From 2016 to 2018, there was a mean of 1.79 apical POP procedures per 1,000 female beneficiaries performed across hospital referral regions (95% CI 1.74-1.84). Rate estimates ranged between 0.87 (95% CI 0.63-1.11) apical POP procedures per 1,000 female beneficiaries (Alexandria, Louisiana) and 3.33 (95% CI 2.91-3.74) per 1,000 beneficiaries (Akron, Ohio), a nearly fourfold difference in rates. Variation between hospital referral regions for abdominal apical prolapse procedures was the greatest (coefficient of variation 0.52). Vaginal and obliterative approaches demonstrated less variation between hospital referral regions (respectively, coefficient of variation 0.36 and 0.40). CONCLUSION: There is wide geographic variation among hospital referral regions for the treatment of POP. Women may be treated differently based on where they live and seek care, which raises questions about possible overuse in some regions and concerns about underuse and lack of access in other regions.

Recommended Citation

Gerjevic KA, Newton H, Leggett C, Skinner J, Erekson E, Strohbehn K. Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse [published online ahead of print, 2022 Mar 10]. Obstet Gynecol. 2022;10.1097/AOG.0000000000004708. doi:10.1097/AOG.0000000000004708