Variation in the Quality of Surgical Care for Uterovaginal Prolapse
The American College of Obstetricians and Gynecologists recommends pelvic floor reconstruction (pexy) procedures to treat uterovaginal prolapse, with or without hysterectomy, but many women receive hysterectomy alone. A study of the relationship of hospital characteristics to compliance with uterovaginal prolapse treatment recommendations found that although high-volume, teaching and private hospitals had better compliance rates than disproportionate share (DSH) and public hospitals, compliance rates were low in all hospital types.
The authors analyzed linked California hospital discharge and financial data for 2002-2006, from the California Office of Statewide Health Planning and Development Patient Discharge Database, and tested associations between hospital characteristics and compliance with treatment recommendations.
All hospital types had low compliance rates, though high-volume, teaching and private hospitals had better compliance rates than DSH and public hospitals. DSH were likely to treat with hysterectomy alone. Teaching hospitals were twice as likely as nonteaching, and private hospitals were 28 percent more likely than public, to provide recommendation-compliant care.
Hospital characteristics are correlated with the way uterovaginal prolapse is treated; however, the nature of the data analyzed did not permit causal associations between hospital characteristics and the kind of care given. Further research could examine whether participation of fellowship-trained specialists increases the likelihood of compliant care.