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Int Urogynecol J. 2019 May;30(5):753-759. doi: 10.1007/s00192-018-3696-1. Epub 2018 Jun 22.

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

Author information

1
Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA. asammarc@med.umich.edu.
2
Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
3
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
4
Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI, USA.
5
Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.

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.

KEYWORDS:

Hysterectomy; Pelvic organ prolapse; Pessary

PMID:
29934768
PMCID:
PMC6470058
[Available on 2020-05-01]
DOI:
10.1007/s00192-018-3696-1

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