Statewide analysis: Significant variation in surgical method for prolapse hysterectomies

Key takeaways:

• Rates of vaginal hysterectomy to treat pelvic organ prolapse ranged from 5.8% to 86.8% in 78 Michigan counties.
• Vaginal hysterectomy was linked to higher rates of concurrent colporrhaphy.

A Michigan statewide analysis found significant variations in surgical approaches for hysterectomies performed to treat pelvic organ prolapse, according to study data.

“We sought to identify if county of residence was independently associated with choice of hysterectomy approach for the treatment of pelvic organ prolapse within a single state. We then sought to quantify differences in concurrent procedures and health care utilization,” Kyle R. Latack, MD, resident in the department of obstetrics and gynecology at the University of Michigan, Ann Arbor, and colleagues wrote. “We hypothesize that there is geographic variation in surgical approach and this variation is associated with metrics of health care utilization.”

Latack and colleagues conducted a retrospective analysis of Blue Cross Blue Shield, Medicare and Medicaid fee-for-service insurance claims for 6,974 hysterectomies performed for uterine prolapse in 78 Michigan counties from October 2015 to December 2021. The primary outcome was variation in surgical approach for hysterectomy on a county level. Utilizing patient home address ZIP codes, researchers determined county of residence.

Results, published in the American Journal of Obstetrics & Gynecology, found that 41.1% of women underwent vaginal hysterectomy, 16% underwent laparoscopic assisted vaginal hysterectomy and 42.9% underwent laparoscopic hysterectomy. Across all evaluated 78 Michigan counties, the proportion of vaginal hysterectomies ranged from 5.8% to 86.8%.

Researchers observed a median OR of 1.86, which was consistent with a high variation level, according to the researchers. However, 37 Michigan counties were considered statistical outliers because the observed vaginal hysterectomy proportion was outside the predicted range.

Compared with laparoscopy-assisted vaginal hysterectomies and laparoscopy hysterectomies, vaginal hysterectomies were associated with higher rates of concurrent colporrhaphy (65.6% and 41.1% vs. 88.5%, respectively; P < .001) and lower rates of concurrent colpopexy (51.7% and 80.1% vs. 45.7%, respectively; P < .001).

“Current guidelines do not establish a well-defined pathway for treatment of prolapse, and data to support strong guidelines for patients with various comorbidities and goals of treatment are not yet available,” the researchers wrote. “As such, variation should be driven by a patient’s unique anatomy and clinical condition through shared decision-making.”