Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support.
Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support.
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DOI：
10.1097/aog.0b013e3182a8a5e4
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发表时间：
2013-11
影响因子：
7.2
通讯作者：
Anger JT
中科院分区：
文献类型：
--
作者：
Eilber KS;Alperin M;Khan A;Wu N;Pashos CL;Clemens JQ;Anger JT
复发性盆腔器官脱垂（POP）可归因于多种因素，其中之一是缺乏阴道顶端支撑。为了评估阴道顶端支撑和 POP 的作用，我们分析了一个国家数据集，以比较使用和不使用顶端支撑进行脱垂手术后的长期再手术率。从医疗保险和医疗补助服务中心获得了 5% 随机全国女性医疗保险受益人样本的公共使用档案数据。 1999 年接受手术的 POP 女性通过相关国际疾病分类第 9 版、临床修改和现行程序术语第 4 版代码进行识别。对个别患者进行随访至 2009 年。脱垂修复术分为前路、后路或前后路修复术，伴或不伴根尖悬吊手术。主要结果是 POP 的再治疗率。 1999 年，有 21,245 名女性被诊断为 POP。其中，当年有 3,244 人（15.3%）接受了脱垂手术。有 2,756 名女性接受了前阴道修补术、后阴道修补术或两者兼而有之，有或没有根尖悬吊术。 10年后，接受单独前牙修复的女性的累积再手术率最高（20.2%），并且显着超过同时接受根尖支撑手术的女性的再手术率（11.6%，p < 0.01）。 POP 手术十年后，当同时进行根尖悬吊手术时，再次手术率显着降低。
Recurrent pelvic organ prolapse (POP) has been attributed to many factors, one of which is lack of vaginal apical support. To assess the role of vaginal apical support and POP, we analyzed a national dataset to compare long-term reoperation rates after prolapse surgery performed with and without apical support. Public Use File data on a 5% random national sample of female Medicare beneficiaries was obtained from the Centers for Medicare and Medicaid Services. Women with POP who underwent surgery during 1999 were identified by relevant International Classification of Diseases, 9th revision, Clinical Modification and Current Procedural Terminology, 4th edition codes. Individual patients were followed through 2009. Prolapse repair was categorized as anterior, posterior, or anterior–posterior with or without a concomitant apical suspension procedure. The primary outcome was the rate of retreatment for POP. In 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery that year. There were 2,756 women who underwent an anterior colporrhapy, posterior colporrhaphy, or both with or without apical suspension. After 10 years, cumulative reoperation rates were highest among women who had an isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%, p < 0.01). Ten years after surgery for POP, the reoperation rate was significantly reduced when a concomitant apical suspension procedure was performed.