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Prolapse Surgery Now Less Common in Women Under 52


 

Major Finding: There was a drop in pelvic organ prolapse procedures from approximately 228,000 procedures performed in 1979 to 186,000 in 2006. This appears to be largely due to a decrease in procedures performed in women under age 52 years.

Data Source: A study of the National Hospital Discharge Survey database from 1979 to 2006.

Disclosures: The National Institutes of Health funded the study. Dr. Jones said she had no relevant disclosures.

HOLLYWOOD, FLA. — The overall number of inpatient surgeries for pelvic organ prolapse decreased over the past few decades, with some interesting trends according to patient age, based on a 1979-2006 study of the National Hospital Discharge Survey database.

“The decrease in overall numbers likely reflects a large decline in procedures in women younger than 52 years,” according to Dr. Keisha Jones. “Rates were stable or slightly increased for women 52 and older.”

Epidemiological data for pelvic organ prolapse are lacking, she said at the annual meeting of the American Urogynecologic Society. So she and her associates evaluated more than 5.6 million prolapse procedures performed from 1979 to 2006. There were approximately 228,000 procedures in 1979 and 186,000 in the final year of the study period, according to ICD-9-CM codes in the database.

The researchers stratified women into two groups—those younger than 52 and those 52 years and older. They chose this cutoff point because 52 is the average age of onset of menopause in the United States.

During the study, mean patient age increased by a decade from 47 years in 1979 to 57 years in 2006, said Dr. Jones, who was an ob.gyn. fellow in the division of female pelvic medicine and reconstructive surgery at Magee-Women's Hospital in Pittsburgh at the time of the study. Dr. Jones is currently a urogynecologist at Baystate Medical Center in Springfield, Mass.

They also looked at age-adjusted surgery rates based on 1990 U.S. census data. The overall rates of prolapse surgery decreased from 2.93/1,000 women in 1979 to 1.56 in 2006. Among younger women, the rate decreased from 3.03 in 1979 to 0.84 in 2006. Among women 52 and older, the rates actually increased slightly, from 2.73 in 1979 to 2.86 in 2006.

They proposed that a dramatic decrease in overall hysterectomies performed for benign indications among women younger than 52 is directly related to the significant decrease in inpatient prolapse procedures in this population.

The overall age-adjusted rates of hysterectomy for benign indications declined from 7.24/1,000 women in 1979 to 4.50 in 2006, most dramatically in women under 52, (from 9.4/1,000 women to 5.1), Dr. Jones said. In contrast, no significant change was observed for hysterectomies in women 52 years and older (from 3.1 in 1979 to 3.3 in 2006).

A total of 35% of women had one or more comorbidities at the time of surgery; oncologic, cardiovascular, and endocrine conditions were the most common. In addition, 29% of women had surgical complications, most often uterine/vaginal inflammation and anemia.

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