Trends in management of pelvic organ prolapse among female Medicare beneficiaries.
Trends in management of pelvic organ prolapse among female Medicare beneficiaries.
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DOI：
10.1016/j.ajog.2014.10.025
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发表时间：
2015-04
影响因子：
9.8
通讯作者：
Anger, Jennifer T.
中科院分区：
文献类型：
--
作者：
Khan, Aqsa A.;Eilber, Karyn S.;Clemens, J. Quentin;Wu, Ning;Pashos, Chris L.;Anger, Jennifer T.
在过去的十年中，许多新的手术治疗方法已经开发出来，以实现微创的方法来治疗脱垂。然而，在过去十年中，盆腔器官脱垂（POP）女性的护理模式可能发生了怎样的变化，以及补片植入技术是否影响了所进行的特定间室修复术的类型方面，数据有限。我们使用了一个国家的数据集来分析POP. Data的护理模式的时间趋势从公共使用文件从医疗保险和医疗补助服务中心的5%随机抽样的国家受益人与国际疾病分类，第九次修订，临床修改诊断的POP从1999年到2009年。使用现行手术术语第4版和国际疾病分类第9版临床修改手术代码评价该队列的非手术和手术管理趋势。手术类型按脱垂隔室和修复组合进行分类。2005年之后，当适用代码可用时，还分析了补片或移植物修复。在研究期间，在我们5%的医疗保险受益人样本中，任何一年内诊断为POP的女性人数保持相对稳定（范围为每年21，245 - 23，268）。在研究期间，子宫托插入率也一致为11-13%。在诊断为脱垂的女性中，14-15%接受了手术修复，并且基于间隔的手术管理模式随着时间的推移几乎没有变化。最常见的是同时修复多个间隔。补片的使用迅速增加，2009年，接受手术的所有女性中有41%（占总队列的5.8%）在其修复中插入了补片或移植物。脱垂的子宫切除率随着时间的推移而下降。子宫脱垂行子宫切除术时穹窿悬吊率较低;然而，随着时间的推移，穹窿悬吊率相对增加（1999年为22%，2009年为26%）。从1999年到2009年，脱垂修复的模式和比率保持相对不变，但补片使用迅速增加。这些数据表明，大多数补片技术仅用于加固目的，但并未导致在美国进行的根尖修复增加。在因POP行子宫切除术的同时，穹窿悬吊修复的发生率仍然很低。
In the last decade, many new surgical treatments have been developed to achieve less-invasive approaches to prolapse management. However, limited data exist on how the patterns of care for women with pelvic organ prolapse (POP) may have changed over the last decade, and whether mesh implantation techniques have influenced the type of specific compartment repair performed. We used a national data set to analyze the temporal trends in patterns of care for women with POP. Data were obtained from Public Use Files from the Centers for Medicare and Medicaid Services for a 5% random sample of national beneficiaries with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of POP from 1999 through 2009. Current Procedural Terminology, 4th Edition and International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes were used to evaluate nonsurgical and surgical management trends for this cohort. Types of surgery were categorized by prolapse compartment and combinations of repairs. After 2005, when applicable codes became available, mesh or graft repairs were also analyzed. Over the study time period, the number of women with a diagnosis of POP in any 1 year in our 5% sample of Medicare beneficiaries remained relatively stable (range, 21,245–23,268 per year). Rates of pessary insertion were also consistent at 11–13% over the study period. Of the women with a prolapse diagnosis, 14–15% underwent surgical repair, and there was little change over time in surgical management patterns based on compartment. Most commonly, multiple compartments were repaired simultaneously. There was a rapid increase in mesh use such that in 2009, 41% of all women who underwent surgery (5.8% of the total cohort) had mesh or graft inserted in their repair. Hysterectomy rates for prolapse decreased over time. Rates of vault suspension at the time of hysterectomy for prolapse were low; however, they showed a relative increase over time (22% in 1999 to 26% in 2009). Patterns and rates of prolapse repairs remained relatively unchanged from 1999 through 2009, with an exception of a rapid rise in mesh use. These data suggest that the majority of mesh techniques were used for augmentation purposes only, but did not result in an increase in apical repairs performed in the United States. There remains a disappointingly low rate of vault suspension repairs concomitantly at time of hysterectomy for POP.
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影响因子：
120.7
作者：
Nygaard, Ingrid;Barber, Matthew D.;Burgio, Kathryn L.;Kenton, Kimberly;Meikle, Susan;Schaffer, Joseph;Spino, Cathie;Whitehead, William E.;Wu, Jennifer;Brody, Debra J.
通讯作者：
Brody, Debra J.
影响因子：
1.8
作者：
Shah, Aparna D.;Kohli, Neeraj;Hoyte, Lennox
通讯作者：
Hoyte, Lennox
影响因子：
7.2
作者：
Daellenbach, Patrick;Kaelin-Gambirasio, Isabelle;Boulvain, Michel
通讯作者：
Boulvain, Michel
DOI：
10.1097/spv.0b013e31827e857c
发表时间：
2013-05-01
影响因子：
1.6
作者：
Alperin, Marianna;Khan, Aqsa;Anger, Jennifer T.
通讯作者：
Anger, Jennifer T.
影响因子：
7.2
作者：
Eilber KS;Alperin M;Khan A;Wu N;Pashos CL;Clemens JQ;Anger JT
通讯作者：
Anger JT