Outcomes of Vaginal Prolapse Surgery Among Female Medicare Beneficiaries: The Role of Apical Support
Open accessAbstract
OBJECTIVE: Recurrent pelvic organ prolapse (POP) has been attributed to many factors, one of which is lack of vaginal apical support. To assess the role of vaginal apical support and POP, we analyzed a national dataset to compare long-term reoperation rates after prolapse surgery performed with and without apical support. METHODS: Public use file data on a 5% random national sample of female Medicare beneficiaries were obtained from the Centers for Medicare and Medicaid Services. Women with POP who underwent surgery during 1999 were identified by relevant International Classification of Diseases, 9th Revision, Clinical Modification, and Current Procedural Terminology, Fourth Edition codes. Individual patients were followed-up through 2009. Prolapse repair was categorized as anterior, posterior, or anterior-posterior with or without a concomitant apical suspension procedure. The primary outcome was the rate of retreatment for POP. RESULTS: In 1999, 21,245 women had a diagnosis of POP. Of these, 3,244 (15.3%) underwent prolapse surgery that year. There were 2,756 women who underwent an anterior colporrhaphy, posterior colporrhaphy, or both with or without apical suspension. After 10 years, cumulative reoperation rates were highest among women who had an isolated anterior repair (20.2%) and significantly exceeded reoperation rates among women who had a concomitant apical support procedure (11.6%; P<.01). CONCLUSION: Ten years after surgery for POP, the reoperation rate was significantly reduced when a concomitant apical suspension procedure was performed. This analysis of a national cohort suggests that the appropriate use of a vaginal apical support procedure at the time of surgical treatment of POP might reduce the long-term risk of prolapse recurrence. LEVEL OF EVIDENCE: II.
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Factors previously found to influence recurrence include age <60 years, postmenopausal status, advanced stages of POP (III-IV), history of complicated delivery, urinary incontinence before POP surgery, widened genital hiatus, high BMI, and failure to perform apical suspension.
“Several factors have been found to influence recurrence of POP; among them, age < 60 years, postmenopausal status, advanced stages of POP (III–IV), history of complicated delivery, urinary incontinence before POP surgery, widened genital hiatus, high body mass index (BMI), and failure to perform apical suspension [12, 13, 16, 17].”
From Risk factors for recurrence of pelvic organ prolapse after vaginal surgery among Ugandan women: a prospective cohort study (2022) · cites this paper as [17]
The Results report higher reoperation rates when anterior or combined anterior–posterior repair was performed without apical support, supporting the apical-suspension factor. The paper does not establish the other listed factors; its Discussion says prolapse severity could not be assessed, and its cohort was aged 65–96, so it could not evaluate age under 60. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe absence of apical support doubles the risk of POP recurrence, and performing McCall-type culdoplasty or high uterosacral ligament suspension during any type of hysterectomy may reduce the risk of apical prolapse.
“According to Eilber et al. [ 25 ] the absence of apical support doubles the risk of POP recurrence and performing McCall-type culdoplasty or high uterosacral ligament suspension during any type of hysterectomy, may reduce the risk of apical prolapse [ 26 – 28 ].”
From Recurrent pelvic organ prolapse after hysterectomy; a 10-year national follow-up study (2024) · cites this paper as [25]
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- Authors
- Eilber, K. S., Alperin, M., Khan, A., Wu, N., Pashos, C. L., Clemens, J. Q., & Anger, J. T.
- Affiliations
- Cedars-Sinai Medical Center (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2013-11
- Volume
- 122
- Issue
- 5
- Pages
- 981-987
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC3857933
- OpenAlex
- W1977885454
- Cited by
- 177
- References
- 12
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 9 · 2023: 19 · 2022: 17 · 2021: 11 · 2020: 17 · 2019: 15 · 2018: 17 · 2017: 20 · 2016: 16 · 2015: 7 · 2014: 7
- FWCI
- 8.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK080227)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD001259)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- pelvic organ prolapse, prolapse recurrence, reoperation rate, anterior colporrhaphy, posterior colporrhaphy, vaginal prolapse surgery, long-term surgical outcomes, Medicare beneficiaries
- MeSH terms
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Medicare, Humans, Recurrence, Reoperation, Gynecologic Surgical Procedures, United States, Uterine Prolapse, Vagina, Cohort Studies, Treatment Outcome
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