Trend in Apical Prolapse Repairs in Commercially Insured Women in the United States over 15 Years

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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S24

women with posterior or anterior prolapse were significantly more likely to have had at least one vaginal delivery (p \ 0.001), to have delivered an infant weighing greater than 4000 g vaginally (p \ 0.001), and to have experienced an anal sphincter laceration (p = 0.030). Women with posterior prolapse were also significantly more likely to have had an operative delivery (p \ 0.001). At enrollment, women with posterior prolapse were more likely than the other two groups to report incontinence of gas (p = 0.011), sensation of a bulge (p \ 0.001), and splinting for bowel movements (p = 0.003). There was no difference between women with anterior or posterior prolapse with respect to incontinence of stool or difficult bowel movements, although both groups were more likely than women with no prolapse to report these symptoms. Incorporating all person-visits in the generalized estimating models resulted similar trends. Conclusion: Obstetric risk factors are similar for anterior and posterior vaginal prolapse. However, women with posterior prolapse are more likely to report incontinence of gas, bulge symptoms, and splinting to complete a bowel movement. Our results suggest that women with stage II posterior prolapse may be experiencing more symptoms than previously appreciated. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: MaryAnn B. Wilbur: Nothing to disclose Kelly McDermott: Nothing to disclose Joan Blomquist: Nothing to disclose Victoria Handa: Nothing to disclose

0.13% in 2003. Vaginal procedures have risen steadily over this period from 51% in 1996 to 67% in 2010. Transvaginal mesh repair rapidly increased from non-existent prior to 2005 to 26.5% of all procedures in 2010. The proportion of mesh procedures among all vaginal procedures steadily increased 39.49% in 2010. Conclusion: MarketScan database collects information on CPT procedure codes and thereby allows categorization of apical prolapse repairs to more precise categories such as vaginal and abdominal and laparoscopic unlike other national databases. This degree of precision is not available in other national datasets such as National Inpatient Sample. Overall number of reported procedures for apical prolapse repairs increased from 1996 to 2010 among women 18-65 years of age with commercial insurance. Up until 2003, abdominal and vaginal procedures for apical prolapse repair were about equally popular. Proportion of abdominal sacrocolpopexy procedures dramatically dropped from about 49% in 1996 to 12% in 2010. This corresponded to an increase in proportion of procedures performed via vaginal route particularly transvaginal mesh repair, and laparoscopic sacrocolpopexy. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Vani Dandolu: Nothing to disclose Shobhana Talukdar: Nothing to disclose Sneha Sura: Nothing to disclose

ORAL PRESENTATION 04 ORAL PRESENTATION 03

Trend in Apical Prolapse Repairs in Commercially Insured Women in the United States over 15 Years Dandolu V, Talukdar S, Sura S. Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada Objectives: To identify the trends pertaining to surgery for apical prolapse repair among commercially insured population in the United States over 15 years. Materials and methods: The data for this study was obtained from 19962010 US Medstat MarketScan Commercial Claims database which contains comprehensive de-identified medical and health-care claims records from Health Maintenance Organizations and preferred providers. Dataset of all patients that underwent surgery for apical prolapse was extracted using appropriate CPT codes. SAS statistical software was used for analysis. Results: We identified women aged 18 to 65 years undergoing repair of apical prolapse from 1996 to 2010 in the United States. There were a total of 53,980 apical prolapse repair procedures reported in the dataset during this time. The abdominal route was used for 11,614 (21.5%) of these procedures while 34,721 procedures (64.3%) were performed vaginally and 7645 (14.1%) performed laparoscopically. Vaginal colpopexies utilized both extra-peritoneal (sacrospinous, ischicoccygeal repair; n = 23,080) and intraperitoneal approaches (uterosacral, levator myorrhaphy; n = 11,641). Mesh utilization rate was 28.74% for extraperitoneal procedures and 8.54% for intraperitoneal procedures during this study period. Overall rate of vaginal repair techniques that involved the use of a mesh (transvaginal mesh repair [TMR]) was 22% while 78% of the vaginal procedures were done without using mesh (transvaginal native tissue repair [TNR]). A comparison of different repair techniques during this period revealed the following trends: the annual number of total procedures reported for all three routes increased steadily from 1996 to 2010. There was a dramatic decrease in the proportion of the abdominal procedures performed over the study period; the abdominal procedures represented 49% in 1996, gradually decreasing to 12% in 2010. The proportion of laparoscopic sacrocolpopexies increased sharply, reaching 20.76% by 2010 from only

Effect of a Decision Aid on Decision Making for the Treatment of Pelvic Organ Prolapse Brazell HD,1 Greene J,2 O’Sullivan DM.3 1Obstetrics and Gynecology, Hartford Hospital, Hartford, Connecticut; 2Administration, Mid State Medical Center, Meriden, Connecticut; 3Research Administration, Hartford Hospital, Hartford, Connecticut Objectives: To determine if the addition of a decision aid (DA) decreases decisional conflict in women presenting for the management of pelvic organ prolapse (POP). Materials and methods: Women scheduled for the evaluation and management of POP were randomized into either of 2 groups: standard counseling alone (n = 50) or standard counseling plus a DA (n = 53). Upon completion of their initial visit, patients filled out a 16-item decisional conflict scale and short form general health survey (SF-12 v2). Values were assessed for normality and compared between groups. Normally distributed, continuous data were evaluated with a Student’s t-test. A chi-square test was used to compare selected categorical characteristics between groups. Differences in distributions of low and high decisional conflict were assessed with a MannWhitney U test. Results: One hundred three women were randomized for this analysis. Baseline characteristics, including pelvic prolapse examination measurements, did not significantly differ between groups (Table 1). The addition of a DA to standard counseling did not significantly lower the level of decisional conflict patients faced when deciding on a treatment plan (p = 0.244). There were no significant differences between groups in uncertainty, values clarity, support, effective decision, and informed subscores. Additionally, there were no between-group differences in choice of treatment plan (conservative management, pelvic floor physical therapy, pessary, and surgery; p = 0.837). Conclusion: In this relatively small sample, the addition of a DA to standard counseling for women with POP does not significantly decrease the level of decisional conflict in making treatment-related decisions. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Hema D. Brazell: Healthwise provided decision aid at no cost John Greene: Nothing to disclose David M. O’Sullivan: Nothing to disclose