Prolapse and continence surgery in countries of the Organization for Economic Co-operation and Development in 2012 - Abstract

OBJECTIVE: The purpose of this study was to report the rates and types of pelvic organ prolapse (POP) and female continence surgery performed in member countries of the Organization for Economic Co-operation and Development (OECD) in 2012.

STUDY DESIGN: The published health outcome data sources of the 34 OECD countries were contacted for data on POP and female continence interventions from 2010-2012. In non-responding countries, data were sought from national or insurer databases. Extracted data were entered into an age-specific International Classification of Disease, edition 10 (ICD-10)-compliant Excel spreadsheet by 2 authors independently in English-speaking countries and a single author in non-English-speaking countries. Data were collated centrally and discrepancies were resolved by mutual agreement.

RESULTS: We report on 684,250 POP and 410,352 continence procedures that were performed in 15 OECD countries in 2012. POP procedures (median rate, 1.38/1000 women; range, 0.51-2.55 prolapse procedures/1000 women) were performed 1.8 times more frequently than continence procedures (median rate, 0.75/1000 women; range, 0.46-1.65 continence procedures/1000 women). Repairs of the anterior vaginal compartment represented 54% of POP procedures; posterior repairs represented 43% of the procedures, and apical compartment repairs represented 20% of POP procedures. Median rate of graft usage was 15.7% of anterior vaginal repairs (range, 3.3-25.6%) and 8.5% (range, 3.2-17%) of posterior vaginal repairs. Apical compartment repairs were repaired vaginally at a median rate of 70% (range, 35-95%). Sacral colpopexy represented a median rate of 17% (range, 5-65%) of apical repairs; 61% of sacral colpopexies were performed minimally invasively. Between 2010 and 2012, there was a 3.7% median reduction in transvaginal grafts, a 4.0% reduction in midurethral slings, and a 25% increase in sacral colpopexies that were performed per 1000 women. Midurethral slings represented 82% of female continence surgeries.

CONCLUSION: The 5-fold variation in the rate of prolapse interventions within OECD countries needs further evaluation. The significant heterogeneity (>10 times) in the rates at which individual POP procedures are performed indicates a lack of uniformity in the delivery of care to women with POP and demands the development of uniform guidelines for the surgical management of prolapse. In contrast, the midurethral slings were the standard female continence surgery performed throughout OECD countries in 2012.

Written by:
Haya N, Baessler K, Christmann-Schmid C, de Tayrac R, Dietz V, Guldberg R, Mascarenhas T, Nussler E, Ballard E, Ankardal M, Boudemaghe T, Wu JM, Maher CF.   Are you the author?
Department of Obstetrics and Gynecology, Royal Brisbane Women's Hospital, Herston, and Wesley Hospital, Brisbane, Queensland, Australia; Department of Obstetrics and Gynecology, Charité University Hospital, Berlin, Germany; Department of Obstetrics and Gynecology, Hospital of Lucerne, Lucerne, Switzerland; Department of Obstetrics and Gynecology, Carémeau University Hospital, Nimes, France; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands; Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark; Department of Obstetrics and Gynecology, Hospital S. João, Porto, Portugal; The National Quality Register of Gynecological Surgery, Department of Clinical Science, Umeå University, Umea, Sweden; Queensland Institute of Medical Research, Brisbane, Queensland, Australia; Department of Obstetrics and Gynecology, Holland Hospital, Halmstad, Sweden; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill NC.  

Reference: Am J Obstet Gynecol. 2015 Feb 25. pii: S0002-9378(15)00153-2.
doi: 10.1016/j.ajog.2015.02.017

PubMed Abstract
PMID: 25724403 Trauma & Reconstruction Section