Abstract

OBJECTIVE: To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse repair as there is a limited understanding of care seeking patterns for repeat surgery after Pelvic Organ Prolapse (POP) repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP.METHODS: In this retrospective population based study, all females who underwent an index POP repair procedure (with or without mesh) at non-federal facilities who subsequently underwent a repeat surgery (recurrent prolapse repair or mesh complication) were identified from the Office of Statewide Health Planning and Development (OSHPD) for the state of California (2005-2011). The location of index repair and repeat surgery were identified and factors associated with migration were explored.RESULTS: Of the 3,930 women who underwent repeat surgery for either POP recurrence or a mesh complication, 1,331 (33.9%) had surgery at a new facility. Multivariate analysis revealed that mesh complications (OR 1.28, p=0.004) or native tissue same compartment recurrence (OR 1.19, p=0.02) were both associated with increased odds of undergoing surgery at a new facility. Having surgery in a county with multiple centers increased the odds of migration to a new facility for care (OR=1.33, p<0.001), unless the initial repair was at a high volume institution (OR=0.32, p<0.001). Overall across indications, women changing locations for their second surgery tended to migrate towards select centers in urban areas.DISCUSSION: Women who undergo repeat surgery after POP repair have similar patterns of migration to a new facility irrespective of the indication for surgery.

View details for PubMedID 30170088