Practice patterns for vaginal hysterectomy and pelvic organ prolapse surgery

Objective: To determine whether current concepts of pelvic organ prolapse and its surgical correction are reflected in community practice by defining community trends in the use of vaginal hysterectomy and other reconstructive surgery for the treatment of pelvic organ prolapse. Methods: All women who underwent a vaginal hysterectomy between January 1994 and October 1999 were identified from the Maryland Health Service Cost Review Commission discharge database. The patients with a primary or secondary diagnosis of pelvic organ prolapse were stratified by concurrent surgery: total vaginal hysterectomy, total vaginal hysterectomy with colporrhaphy, and total vaginal hysterectomy with prolapse procedure. The different surgical groups were compared on the basis of diagnosis, length of stay, and cost. Results: Of the 16,120 total vaginal hysterectomies performed, 49% had a primary or secondary diagnosis of pelvic organ prolapse. Of the women with pelvic organ prolapse, 30% were treated with vaginal hysterectomy alone, 57% with vaginal hysterectomy plus colporrhaphy, and 13% with vaginal hysterectomy plus prolapse surgery. Women with pelvic organ prolapse who underwent surgical repair limited to total vaginal hysterectomy included 23% of those with a primary diagnosis of pelvic organ prolapse and 49% of those with a secondary diagnosis. The average length of stay and cost was significantly higher for the women treated with vaginal hysterectomy plus prolapse surgery as compared with those treated with hysterectomy alone. Conclusions: Current practice trends in Maryland may not reflect an application of the current concepts of pelvic organ prolapse and its surgical correction. Less than 13% of patients were treated with a total vaginal hysterectomy along with a specific procedure aimed at resuspending the vaginal apex. An increase in physician education is warranted.