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You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122141 OUTCOMES OF VAGINAL PROLAPSE SURGERY AMONG FEMALE MEDICARE BENEFICIARIES: THE ROLE OF APICAL SUPPORT Karyn Eilber, Stephanie Histed, Aqsa Khan, Marianna Alperin, Ning Wu, Chris L. Pashos, J. Quentin Clemens, and Jennifer Anger Karyn EilberKaryn Eilber Los Angeles, CA More articles by this author , Stephanie HistedStephanie Histed Los Angeles, CA More articles by this author , Aqsa KhanAqsa Khan Los Angeles, CA More articles by this author , Marianna AlperinMarianna Alperin Los Angeles, CA More articles by this author , Ning WuNing Wu Lexington, MA More articles by this author , Chris L. PashosChris L. Pashos Lexington, MA More articles by this author , J. Quentin ClemensJ. Quentin Clemens Ann Arbor, MI More articles by this author , and Jennifer AngerJennifer Anger Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2312AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent vaginal prolapse has been attributed to lack of apical support. We reviewed a national dataset to compare long-term reoperation rates after prolapse surgery with and without apical support. METHODS Public Use File data on a 5% national random sample of female Medicare beneficiaries 65 years and older were obtained from the Centers for Medicare and Medicaid Services (CMS). Women with pelvic organ prolapse (POP) who underwent prolapse surgery during 1999 were identified by relevant ICD-9 and CPT-4 codes. These patients were then tracked through the end of 2009. Prolapse repair was categorized as anterior, posterior, or anterior-posterior with or without a concomitant apical suspension procedure. RESULTS In 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery during that year. 2,756 women had an anterior and/or posterior repair with or without apical suspension. In the 10-year tracking period, cumulative reoperation rates were highest in women who had an isolated anterior repair (20.2%). Women who had an anterior repair without apical suspension had significantly higher reoperation rates compared to women who did have a concomitant procedure for apical support (20.2% vs. 11.6%, respectively, p < 0.03). A similar trend was observed for patients who had anterior-posterior repair (14.7% vs. 10.2%, respectively). CONCLUSIONS Ten years following prolapse surgery, isolated anterior repair had the highest reoperation rate, but this was significantly reduced when a concomitant apical suspension procedure was performed. A higher reoperation rate was also found for women who underwent anterior-posterior repair without an apical procedure. Though claims-based data is limited by lack of detail regarding POP stage, it does provide novel population-based information regarding the association of apical support and long-term prolapse recurrence. Reoperation rates after prolapse surgery, cumulative number (%) Post-Operative Treatment Anterior Anterior + Apical Posterior Posterior + Apical Anterior/Posterior Anterior/Posterior +Apical n 382 256 246 241 469 1160 Non-surgical (pessary) 6.0% 5.0% 6.1% 5.0% 4.3% 5.00% Any surgery 20.2%⁎ 11.6%⁎ 14.6% 12.9% 14.7%⁎ 10.2%⁎ Colpocleisis 1.3% 0.8% 0.0% 1.2% 0.9% 0.5% Anterior 4.2% 1.9% 3.3% 2.5% 2.3% 1.8% Anterior/Apical 1.0% 0.0% 0.0%⁎ 2.1%⁎ 0.6% 1.3% Anterior/Posterior 2.9% 1.6% 1.6% 3.7% 1.9% 1.0% Anterior/Posterior/Apical 4.2% 1.6% 2.0% 1.7% 3.2% 2.1% Posterior 4.7% 3.1% 4.5%⁎ 0.4%⁎ 1.7%* 1.4%* Posterior/Apical 4.7% 2.3% 1.6% 1.2% 1.5% 1.4% Apical 4.7% 3.1% 2.4% 3.7% 3.4% 2.9% ⁎ p < 0.03 between groups with or without apical repair © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e865 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karyn Eilber Los Angeles, CA More articles by this author Stephanie Histed Los Angeles, CA More articles by this author Aqsa Khan Los Angeles, CA More articles by this author Marianna Alperin Los Angeles, CA More articles by this author Ning Wu Lexington, MA More articles by this author Chris L. Pashos Lexington, MA More articles by this author J. Quentin Clemens Ann Arbor, MI More articles by this author Jennifer Anger Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...