The following is a summary of “Transition to surgery after pessary among female Medicare beneficiaries with pelvic organ prolapse,” published in the MAY 2023 issue of Obstetrics and Gynecology by Meister, et al.

The utilization of vaginal pessaries as a treatment option for pelvic organ prolapse is recommended by the American College of Obstetricians and Gynecologists. However, limited evidence exists regarding the proportion of women fitted with a pessary who ultimately undergo surgery, particularly in a larger population. Single-institution studies have suggested a potential transition to surgery within the first year after pessary fitting. For a longitudinal cohort study, researchers sought to estimate the proportion of female US Medicare beneficiaries aged 65 years and older with pelvic organ prolapse who undergo surgery following pessary fitting. Additionally, the study sought to determine the median time to surgery from the initial pessary fitting and identify factors associated with the transition from pessary to surgery.

Data from the Medicare 5% Limited Data Set spanning 2011 to 2016 were analyzed. The study included women diagnosed with prolapse who underwent pessary fitting and had at least 3 years of follow-up in the Medicare Data Set. The primary outcome was the occurrence of surgery for prolapse after pessary fitting. The cumulative incidence of prolapse surgery was calculated, and time-varying Cox regression analysis was employed to compare the characteristics of women who underwent surgery with those who did not.

Among the 2,032 women fitted with a pessary, 608 underwent surgery within a 7-year period. The median time to surgery was 496 days (interquartile range: 187-1,089 days). The cumulative incidence of prolapse surgery after pessary fitting was 12.2% at 1 year and 30.9% at 7 years. Adjusting for covariates, factors significantly associated with the transition to surgery included prior prolapse surgery and a diagnosis of urinary incontinence at the time of pessary fitting. Conversely, age, dual Medicare/Medicaid eligibility, and pessary fitting by a non-gynecologist were associated with a lower hazard of surgery.

In the study involving Medicare beneficiaries aged 65 years and older, approximately one-third of women underwent surgery for prolapse within 7 years of pessary fitting. The findings contributed important insights into the utilization of pessaries in an older population and can aid in counseling older patients seeking treatment for symptomatic pelvic organ prolapse.

Source: ajog.org/article/S0002-9378(23)00009-1/fulltext