Use of Colpopexy during Laparoscopic Hysterectomy for Pelvic Organ Prolapse

Objectives: We sought to evaluate geographic and patient attributes, and temporal trends associated with endoscopic colpopexy at time of laparoscopic hysterectomy for pelvic organ prolapse (POP) repair.

Methods: We performed a retrospective analysis of Blue Cross Blue Shield, Medicare, and Medicaid insurance claims of laparoscopic hysterectomies performed for POP in Michigan between October 2016 and December 2021. Laparoscopic hysterectomies were identified with Current Procedure Terminology (CPT) codes and a concurrent endoscopic colpopexy was identified with CPT code 57425 (laparoscopy, surgical, colpopexy). The annual proportion of laparoscopic hysterectomies for prolapse accompanied by endoscopic colpopexy was the primary outcome. Patient attributes included age in deciles, medical comorbidities (obesity, congestive heart failure [CHF], chronic obstructive pulmonary disease [COPD], diabetes, and vascular disease), and type of health insurance. Geographic variables were the Centers for Disease Center’s social vulnerability index associated with the patient’s zip code and metro versus non-metropolitan location, also identified with patient’s zip code. A multivariable logistic regression was performed to adjust for patient and geographic factors and year when procedure was performed.

Results: There were 2,990 laparoscopic hysterectomies for prolapse of which 69.3% (n=2,072) underwent concomitant endoscopic colpopexy. During the study time period, the rate of colpopexy increased from 71.9% to 73.9%, with older patients (OR 1.03 95% 1.02-1.03) increasingly more likely to undergo colpopexy. The only patient comorbidity associated with a decreased odds of colpopexy was CHF (OR 0.51 95% CI 0.29-0.90). There was a significant interaction between year and patient location. The odds of a concurrent endoscopic colpopexy decreased yearly for patients from non-metropolitan areas compared to those from metropolitan areas (OR 0.8; 95% CI 0.7-0.9). The annual proportion of patients undergoing a concomitant endoscopic colpopexy decreased among those from a non-metropolitan location (83.8%. to 73.0%) and increased among those from a metropolitan location (67.1% to 74.1%) (Figure 1). Over the course of the study period, the odds of a patient undergoing an endoscopic colpopexy went from being significantly higher in a nonmetropolitan versus a metropolitan area in 2016 to no statistical difference by 2021 (Figure 2).

Conclusions: This analysis demonstrates that use of endoscopic colpopexy at time of laparoscopic hysterectomy for POP repair is changing and independently associated with geographic location of the patient. Older patients are also increasingly likely to undergo endoscopic colpopexy and with the exception of congestive heart failure, patient comorbidities are not a factor in its use.