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International Urogynecology Journal

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01-05-2019 | Original Article

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse

Authors: Anne G. Sammarco, Daniel M. Morgan, Neil S. Kamdar, Carolyn W. Swenson

Published in: International Urogynecology Journal | Issue 5/2019

Abstract

Objectives

To (1) determine the proportion of hysterectomy cases with documentation of pessary counseling prior to prolapse surgery and (2) identify variables associated with women offered a pessary.

Study design

The Michigan Surgical Quality Collaborative (MSQC) is a hysterectomy improvement initiative. Hysterectomies from 2013 to 2015 in which prolapse was the principal diagnosis were included. “Pessary offer” was defined as documentation showing the patient declined, could not tolerate, or failed a pessary trial. Bivariate analyses were used to compare demographics, medical history, surgical route, concomitant procedures (colpopexy or colporrhaphy), and intra- and postoperative complications between women with and without pessary offer. Hierarchical logistic regression was used to determine factors independently associated with pessary offer. Risk-adjusted pessary offer rates by hospital were calculated.

Results

The adjusted rate of pessary offer was 25.2%, ranging from 3 to 76% per hospital. Bivariate comparisons showed differences between women with and without pessary offer in age, tobacco use, prior pelvic surgery, insurance status, surgical approach, secondary indication for surgery, concomitant prolapse procedure, teaching hospital status and hospital bed size. In logistic regression, odds of pessary offer increased with age > 55 years (OR 1.45, 95% CI 1.12–1.88, p = 0.006), Medicare insurance (OR 1.65, 95% CI 1.30–2.10, p < 0.0001), and a concomitant procedure (OR 1.5, 95% CI 1.16–1.93, p = 0.002). Postoperative urinary tract infections were more common in patients offered a pessary (6.4% vs. 2.5%, p < 0.0001), but other complications were similar.

Conclusions

Overall, only one-quarter of hysterectomies for prolapse in MSQC hospitals had documentation of pessary counseling—suggesting an opportunity to improve documentation, counseling regarding pessary use, or both.

Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. https://doi.org/10.1001/jama.300.11.1311.CrossRefPubMedPubMedCentral

Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–90. https://doi.org/10.1007/s00192-013-2169-9.CrossRefPubMed

Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, Handa VL (2007) The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol 196(4):405.e401–408. https://doi.org/10.1016/j.ajog.2007.02.018

Cheung RYK, Lee JHS, Lee LL, Chung TKH, Chan SSC. Vaginal pessary in women with symptomatic pelvic organ prolapse: a randomized controlled trial. Obstet Gynecol. 2016;128(1):73–80. https://doi.org/10.1097/aog.0000000000001489.CrossRefPubMed

Robert M, Schulz JA, Harvey M-A. Technical update on pessary use. J Obstet Gynaecol Can. 2013;35(7):664–74. https://doi.org/10.1016/S1701-2163(15)30888-4.CrossRefPubMed

Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9. https://doi.org/10.1097/01.AOG.0000222903.38684.cc.CrossRefPubMed

Trowbridge ER, Fenner DE. Practicalities and pitfalls of pessaries in older women. Clin Obstet Gynecol. 2007;50(3):709–19. https://doi.org/10.1097/GRF.0b013e3180d0a4ce.CrossRefPubMed

Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(4):1025–9. https://doi.org/10.1016/j.ajog.2003.10.711.CrossRefPubMed

Ding J, Chen C, Song XC, Zhang L, Deng M, Zhu L. Successful use of ring pessary with support for advanced pelvic organ prolapse. Int Urogynecol J. 2015;26(10):1517–23. https://doi.org/10.1007/s00192-015-2738-1.CrossRefPubMed

10.

Hanson LA, Schulz JA, Flood CG, Cooley B, Tam F. Vaginal pessaries in managing women with pelvic organ prolapse and urinary incontinence: patient characteristics and factors contributing to success. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(2):155–9. https://doi.org/10.1007/s00192-005-1362-x.CrossRefPubMed

11.

Lone F, Thakar R, Sultan AH. One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires. Int Urogynecol J. 2015;26(9):1305–12. https://doi.org/10.1007/s00192-015-2686-9.CrossRefPubMed

12.

Practice Bulletin No. 185: Pelvic Organ Prolapse. Obstet Gynecol. 2017;130(5):e234-e250. https://doi.org/10.1097/aog.0000000000002399.

13.

Campbell DA, Kubus JJ, Henke PK, Hutton M, Englesbe MJ. The Michigan surgical quality collaborative: a legacy of Shukri Khuri. A J Surg. 2009;198(5, Supplement):S49–55. https://doi.org/10.1016/j.amjsurg.2009.08.002.CrossRef

14.

Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. Arch Surg. 2002;137(1):20–7.CrossRefPubMed

15.

American College of Surgeons. User Guide for the 2012 ACS NSQIP Participant use data file. 2013. https://www.facs.org/~/media/files/quality%20programs/nsqip/ug12.ashx. Accessed 17 April 2018.

16.

Waits SA, Fritze D, Banerjee M, Zhang W, Kubus J, Englesbe MJ, et al. Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery. Surgery. 2014;155(4):602–6. https://doi.org/10.1016/j.surg.2013.12.004.CrossRefPubMed

17.

Corona LE, Swenson CW, Sheetz KH, Shelby G, Berger MB, Pearlman MD, et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol. 2015;212(3):304.e301–7. https://doi.org/10.1016/j.ajog.2014.11.031.CrossRef

18.

Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2(5):281–4.CrossRef

19.

Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA. A survey of pessary use by members of the American urogynecologic society. Obstet Gynecol. 2000;95(6 Pt 1):931–5.PubMed

20.

Pulliam SJ, Morgan DM, Guaderrama N, Guire K, Adam RA. Differences in patterns of preoperative assessment between high, intermediate, and low volume surgeons when performing hysterectomy for Uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2016;22(1):7–10. https://doi.org/10.1097/spv.0000000000000204.CrossRefPubMed

21.

Kammerer-Doak D, Svabik K, Bazi T. Variability in practice patterns in stress urinary incontinence and pelvic organ prolapse: results of an IUGA survey. Int Urogynecol J. 2017;28(5):735–44. https://doi.org/10.1007/s00192-016-3174-6.CrossRefPubMed

22.

Velzel J, Roovers JP, Van der Vaart CH, Broekman B, Vollebregt A, Hakvoort R. A nationwide survey concerning practices in pessary use for pelvic organ prolapse in the Netherlands: identifying needs for further research. Int Urogynecol J. 2015;26(10):1453–8. https://doi.org/10.1007/s00192-015-2697-6.CrossRefPubMedPubMedCentral

23.

Khan AA, Eilber KS, Clemens JQ, Wu N, Pashos CL, Anger JT. Trends in management of pelvic organ prolapse among female Medicare beneficiaries. Am J Obstet Gynecol. 2015;212(4):463.e461–8. https://doi.org/10.1016/j.ajog.2014.10.025.CrossRef

24.

Panman CM, Wiegersma M, Kollen BJ, Burger H, Berger MY, Dekker JH. Predictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice. Int Urogynecol J. 2017;28(2):307–13. https://doi.org/10.1007/s00192-016-3107-4.CrossRefPubMed

25.

Amrock LG, Neuman MD, Lin H-M, Deiner S. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684–94. https://doi.org/10.1016/j.jamcollsurg.2014.04.018.CrossRefPubMedPubMedCentral

26.

Wunsch H, Gershengorn HB, Guerra C, Rowe J, Li G. Association between age and use of intensive care among surgical Medicare beneficiaries. J Crit Care. 2013;28(5):597–605. https://doi.org/10.1016/j.jcrc.2013.05.003.CrossRefPubMedPubMedCentral

27.

George EM, Tergas AI, Ananth CV, Burke WM, Lewin SN, Prendergast E, et al. Safety and tolerance of radical hysterectomy for cervical Cancer in the elderly. Gynecol Oncol. 2014;134(1):36–41. https://doi.org/10.1016/j.ygyno.2014.04.010.CrossRefPubMedPubMedCentral

28.

Ross WT, Meister MR, Shepherd JP, Olsen MA, Lowder JL. Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate. Am J Obstet Gynecol. 2017;217(4):436.e431–8. https://doi.org/10.1016/j.ajog.2017.07.010.CrossRef

29.

Sutkin G, Alperin M, Meyn L, Wiesenfeld HC, Ellison R, Zyczynski HM. Symptomatic urinary tract infections after surgery for prolapse and/or incontinence. Int Urogynecol J. 2010;21(8):955–61. https://doi.org/10.1007/s00192-010-1137-x.CrossRefPubMed

Title: Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse
Authors: Anne G. Sammarco
Daniel M. Morgan
Neil S. Kamdar
Carolyn W. Swenson
Publication date: 01-05-2019
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 5/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3696-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse

Abstract

Objectives

Study design

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Study design

Results

Conclusions

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