For a study, researchers sought to determine the regional variance in rates of apical support surgeries for the treatment of pelvic organ prolapse (POP) among female Medicare enrollees. They analyzed 100% Medicare fee-for-service claims to identify a cohort of women aged 65–99 years who underwent an apical support operation, as described by Current Procedural Terminology codes, between 2016 and 2018. All vaginal and abdominal techniques (native tissue and mesh colpopexies) and obliterative operations were considered. They eliminated vaginectomies with a gynecologic cancer diagnosis but no prolapse diagnosis. They calculated coefficients of variation to quantify the degree of regional variation in rates of apical POP operations by hospital referral location.
From 2016 to 2018, an average of 26,005 apical POP operations were done every year. The majority of patients (64.3%) were between the ages of 65 and 74, and 28.5% underwent hysterectomy as well. Between 2016 and 2018, a total of 1.79 apical POP operations were done per 1,000 female participants across hospital referral areas (95% CI 1.74–1.84). Rate estimates varied from 0.87 (95% CI 0.63–1.11) apical POP operations per 1,000 female beneficiaries to 3.33 (95% CI 2.91–3.74) per 1,000 beneficiaries representing a nearly fourfold disparity in rates. For abdominal apical prolapse surgeries, the biggest difference was found between hospital referral areas (coefficient of variation 0.52). There was less heterogeneity across hospital referral locations for vaginal and obliterative techniques (respectively, the coefficient of variation was 0.36 and 0.40).
For the treatment of POP, there was a large regional difference among hospital referral regions. Women may be treated differently depending on where they live and seek treatment, raising concerns about overuse in some areas and underuse and lack of access in others.
