Apical Support Procedure at the Time of Hysterectomy: Regional experience at one tertiary care institution

Background To investigate the rate of performance of concomitant apical support procedure at time of benign hysterectomy for uterovaginal prolapse at one tertiary care institution. Methods This was a retrospective cohort study of patients who underwent benign hysterectomy at our institution over a 22-year period. Eligible patients were identified by ICD and CPT codes and data were abstracted retrospectively. Factors associated with performance of an ASP were investigated and compared using multivariable logistic regression. Results 388 patients underwent benign hysterectomy with a diagnosis of prolapse. The mean age was 58 (SD 13); most were white (325, 83.8%), non-Hispanic (375, 92.0%), with private insurance (193, 49.7%). 259 (66.7%) had uterovaginal prolapse and of those, 203 (70.2%) underwent an apical support procedure. On multivariable analysis, patients were nearly 3-fold more likely to undergo an ASP if they had a diagnosis of uterovaginal prolapse and nearly 70% less likely to undergo an ASP if their procedure was performed by a general gynecologist without a sub-specialist. Conclusions At our institution, approximately 75% of benign hysterectomies performed for prolapse incorporate an apical support procedure. Although this is better than the rates in other regions, ongoing efforts to educate surgeons, particularly non-subspecialists, on the importance of re-establishing apical vaginal support at time of hysterectomy for prolapse is needed.