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10253_Swenson
10253_Swenson
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The aim of this study was to determine the rate of documentation of pessary counseling prior to hysterectomies done for pelvic organ prolapse (POP) and identify variables associated with women being offered a pessary. The data used was from the Michigan Surgical Quality Collaborative (MSQC), which collects perioperative data through chart reviews. The study included 3,138 hysterectomies for POP at 62 hospitals, with 3,000 hysterectomies included in the final analysis at 47 hospitals.<br /><br />The results showed that surgery for POP is common, and women considering treatment for POP should be offered a vaginal pessary as an alternative to surgery, as recommended by ACOG and AUGS. However, there was wide variation in pessary counseling prior to hysterectomy, with only a quarter of cases having documentation of pessary counseling. This indicates a need for improvement in the documentation and counseling for pessary use as an initial management option for prolapse.<br /><br />Factors associated with the offer of a pessary included age, tobacco use, prior pelvic surgery, insurance status, hysterectomy approach, teaching hospital status, and hospital bedsize greater than 500. The average rate of pessary offer was 25.1%, but there was significant variation among hospitals, ranging from 2.9% to 75.8%.<br /><br />In conclusion, this study highlights the variation in pessary counseling prior to surgery for pelvic organ prolapse and the opportunity for improvement in the documentation and counseling for pessary use. It suggests the need for standardized guidelines and protocols to ensure that women are offered all appropriate treatment options for POP, including the use of a pessary.
Keywords
pessary counseling
hysterectomies
pelvic organ prolapse
perioperative data
vaginal pessary
prolapse management
factors associated with pessary offer
variation in pessary offer
standardized guidelines
treatment options
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