Patterns of Pessary Care and Outcomes for Medicare Beneficiaries With Pelvic Organ Prolapse
Patterns of Pessary Care and Outcomes for Medicare Beneficiaries With Pelvic Organ Prolapse
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DOI：
10.1097/spv.0b013e31827e857c
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发表时间：
2013-05-01
影响因子：
1.6
通讯作者：
Anger, Jennifer T.
中科院分区：
文献类型：
--
作者：
Alperin, Marianna;Khan, Aqsa;Anger, Jennifer T.
目的：使用一个国家的数据集，我们试图评估模式的子宫托护理在老年妇女盆腔器官脱垂（POP）和随后的结果，包括并发症和手术治疗的POP.Methods率：公共使用文件从美国医疗保险和医疗补助服务中心获得了5%的随机国家样本的受益人从1999年至2000年。诊断和程序代码（国际疾病分类，第九次修订，临床修改和现行程序术语，第4版）被用来确定妇女与POP和阴道栓治疗。个体受试者纵向随访9年。在此期间，患者的护理和结果（如，回访诊所，反复放置子宫托，并发症，手术治疗脱垂率）进行了assessed.Results：34,782名妇女的条件诊断为POP，4019名妇女（11.6%）与子宫托治疗。在放置子宫托后的最初3个月内，40%的患者接受了放置子宫托的提供者的随访，并且在首次安装后的9年内，69%的患者接受了此类随访。在此期间，3%的受试者发生膀胱阴道瘘或直肠阴道瘘，5%的受试者发生机械性泌尿生殖器器械并发症。百分之十二的妇女接受手术治疗POP的1年，24%的9 years.Conclusions：阴道栓可以有效地用于管理老年妇女的POP。尽管如此，医疗保险受益人接受子宫托安装的比例很低。缺乏连续性的护理与阴道瘘的发生率小但不可接受有关。
Objectives: Using a national data set, we sought to assess patterns of pessary care in older women with pelvic organ prolapse (POP) and subsequent outcomes, including rates of complications and surgical treatment of POP.Methods: Public use files from the US Centers for Medicare and Medicaid Services were obtained for a 5% random national sample of beneficiaries from 1999 to 2000. Diagnostic and procedural codes (International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology, 4th Edition) were used to identify women with POP and those treated with pessary. Individual subjects were followed longitudinally for 9 years. Across this duration, patient care and outcomes (eg, return clinic visits, repeated pessary placements, complications, and rate of surgical treatment of prolapse) were assessed.Results: Of 34,782 women with a condition diagnosed as POP, 4019 women (11.6%) were treated with a pessary. In the initial 3 months after pessary placement, 40% underwent a follow-up visit with the provider who had placed the pessary, and through 9 years after the initial fitting, 69% had such a visit. During this period, 3% of the subjects developed vesicovaginal or rectovaginal fistulas, and 5% had a mechanical genitourinary device complication. Twelve percent of women underwent surgery for POP by 1 year; with 24% by 9 years.Conclusions: Pessary can be effectively used for the management of POP in older women. Despite this, a low percentage of Medicare beneficiaries undergo pessary fitting. Lack of continuity of care is associated with a small but unacceptable rate of vaginal fistulas.