Pelvic Organ Prolapse surgery in the Netherlands in 2005 and 2010

Introduction: Pelvic organ prolapse (POP) is defined as the descent of one or more of the pelvic organs in women. The prevalence of POP is rising. Most patients who seek help for their condition tend to choose surgery as treatment. Hereby the amount of POP surgery is increasing, also in the Netherlands. In uterine prolapse, surgical treatment can be either uterus preserving or by hysterectomy. There is an overall trend towards more uterus preserving surgery in the Netherlands. Whether the approach to uterine prolapse differs between different (types of) hospitals is unknown. In reintervention surgery for uterine or vaginal vault prolapse, abdominal sacrocolpopexy is recently considered to be the gold standard. It is not know if this knowledge has led to an increase in performing abdominal prolapse surgery in the Netherlands. Practice pattern variation (PPV) is defined as the difference in care that cannot be explained by the underlying medical condition. It can be caused by non-compliance to evidence based practice standards, lack of evidence for optimal treatment, or can be caused by a difference in skills or (lack of) resources. PPV is considered to be one of the greatest problems in controlling medical costs. It is not known how large the PPV for POP surgery is. Mesh augmented surgery has gained popularity in the field of POP surgery and it is unknown to what extend this applies to to the Netherlands and how big PPV is. The aim of this study is to get insight in the surgical approach in uterine prolapse, the proportion of abdominal prolapse surgery in the Netherlands, and the PPV in POP surgery and mesh augmented surgery, comparing 2005 with 2010. Methods: Annual reports of 2005 and 2010 were collected from Dutch gynecological departments. If reports were lacking, the necessary information was traced by other ways if possible. The hospitals were subdivided in university, teaching-, and non-teaching hospitals. Practice pattern variation per hospital was defined as the number of procedures per 1000 registered first clinical visits (FCV) to the gynecological department. Results: Data were collected from 60 out of 94 Dutch hospitals (64%) from both 2005 and 2010. In treatment of uterine prolapse, a significant increase in uterine preserving procedures was found between 2005 (14,5% ± 22,1) and 2010 (44,2% ± 33,7) ( p<0,01). An increase was found in all hospital types. The proportion of the uterus preserving techniques or vaginal hysterectomies was randomly distributed over all hospitals, ranging from 0 – 100%, but this did not significantly differ per hospital type (H(2)=3,363, p=0,186). The total amount of abdominal POP procedures did not significant differ between 2005 and 2010 (Z=1,208, p=0,227), however laparoscopic procedures were slightly more performed (+14). In 2010 the PPV for the total amount of POP procedures ranged from 4,2 – 99 procedures per 1000 FCV and for mesh use from 0,11 – 66 procedures per 1000 FCV. Non-teaching hospitals performed significant more POP procedures per 1000 FCV than teaching hospitals (U=204, p