Surgery for Pelvic Organ Prolapse in 1999
Drs. M. A.  Nihira, M. Corton, J. I. Schaffer
University of Texas Southwestern
Dallas, Texas

Objective:   To examine the number of procedures performed, patient characteristics, third party payers, length of stay, hospital characteristics and mortality for patients admitted for pelvic organ prolapse in the United States in 1999.
Methods:   We queried the Solucient Projected Inpatient Database for 1999 for the following ICD-9 procedure codes:  70.5-Repair of cystocele and/or rectocele, 70.77-Vaginal suspension and fixation, 70.79-Other repair of vagina (Colpoperineoplasty, Repair of old obstetric laceration of vagina) and 70.8-Obliteration of vaginal vault.  We excluded hysterectomy for uterine prolapse because there are not specific procedure codes for this indication.  This projected database is based upon over 12 million inpatient discharges from nearly 2,500 acute care American hospitals (approximately one-third of all US hospitals).  The specific data obtained from these facilities are statistically adjusted to represent all the nonfederal, general, short stay hospitals in the United States
Results:   In 1999 there were 168,538 total projected procedures performed.  Almost one-half (49.9%) were performed on patients over 60 years of age.  Twenty-seven percent were older than 70.  Thirty-nine percent were between the ages of 40 and 59.  The majority of the procedures (81%) were cystocele and/or rectocele repairs.  There were 2,346 (1.4%) vaginal vault obliteration procedures.  Fifty-six percent were principally billed to commercial insurance; whereas 33% were principally billed to Medicare.  Eighty-three percent of patients were discharged in three days or less.  Sixty-two percent of the procedures were performed in hospitals with less than 300 beds.  Only 18% of the procedures were performed in teaching hospitals.  Overall, there were 19 projected deaths for a cumulative mortality rate of 0.43 per 1000 procedures where the principal procedure was for pelvic organ prolapse.  Notably, the mortality rate for vaginal vault obliteration was 5 per 1000 procedures.
Conclusions:   In 1999 there were a projected nearly 170,000 procedures performed for pelvic organ prolapse.  This is an underestimate of the total number of procedures performed because hysterectomy for prolapse was excluded.  It is notable that the majority of women were under the age of 60 with approximately 40% between the ages of 40 to 59.  Conversely, almost one-third were over the age of 70.  Gynecologists have been observing that the number of women referred for pelvic support problems has been increasing.  Given the fact that the proportion of women over the age of 60 is growing, the reason for this observation is obvious.  In the future we can expect that more and more women will require surgery for pelvic support problems.  This observation has important implications for policy makers as well as those training physicians in prolapse surgery. 
Key Words:   Prolapse, Cystocele, Rectocele, Epidemiology