Long-Term Risk of Prolapse Retreatment After Hysterectomy for Prolapse.

INTRODUCTION AND HYPOTHESIS: Data on prolapse retreatment related to surgical approach and concurrent use of colporrhaphy or colpopexy at time of hysterectomy for prolapse repair are needed. This study sought to quantify prolapse retreatment as it relates to surgical approach for hysterectomy and use of concurrent procedures.

METHODS

We conducted a retrospective analysis of deidentified private payor insurance claims data for services for hysterectomies for prolapse from October 2015-2024. The primary outcome was prolapse retreatment defined as either a subsequent prolapse procedure or pessary fitting following the index hysterectomy. Data were analyzed using crude incidence rates as well as multivariable Cox proportional hazards models. The adjusted model included patient attributes-e.g., age, comorbidities, concurrent gynecologic diagnoses- geographic factors, and concurrent prolapse procedure(s).

RESULTS

We identified 7017 patients who underwent hysterectomy with a prolapse diagnosis with a mean age of 51.3. A concurrent prolapse procedure was performed in 82% of the hysterectomies. Within the study period, there were 24,129 person-years at risk and 399 patients (5.7%) were retreated. The overall incidence rate of retreatment was 16.5 per 1000 person-years (95% CI 14.9, 18.2). With adjustment for patient and surgical characteristics, including concurrent colporrhaphy and colpopexy, there was no difference in retreatment with a laparoscopic approach compared to vaginal (aHR 1.39, 95% CI 0.95, 2.04). With concurrent colpopexy and colporrhaphy, an abdominal approach was associated with increased retreatment compared to both laparoscopic (aHR 4.8, 95% CI 2.79, 8.25) and vaginal (aHR 6.7, 95% CI 3.8, 11.8) approaches.

CONCLUSIONS

In this cohort of commercially insured women undergoing hysterectomy with a prolapse diagnosis, there was no association between prolapse retreatment and a vaginal versus laparoscopic approach.