Role of Hysterectomy at the Time of Native Pelvic Organ Prolapse Repair

Objective: The goal of this research was to evaluate no concomitant hysterectomy versus concomitant hysterectomy at the time of pelvic organ prolapse (POP) repair. Materials and Methods: This was an observational cohort study involving inpatient and ambulatory surgery settings in New York State. Women younger than 55 without prior hysterectomies who underwent POP repair between 2009 and 2014 were included. POP repairs included apical support in efforts to equate grade of prolapse. Determinations were made regarding 90-day safety events and reintervention, urinary retention, and pelvic pain within 1 year and 3 years following the initial procedure. Results: There were 1564 (71.3%) patients who underwent concurrent hysterectomy at the time of POP surgery, while 629 (28.7%) did not undergo hysterectomy. No differences were found in reinterventions and pelvic pain within 1 year or 3 years after POP repair. Over the study period, we observed increased utilization of concurrent hysterectomy of 46.4% in the most recent study year (p=0.02). After propensity score matching, patients in the concurrent hysterectomy group had more surgical complications and had more expensive charges. Conclusions: Concurrent hysterectomy was more expensive and had more surgical complications within 90 days of the initial procedure, compared to not undergoing hysterectomy. Long-term outcomes were not compromised and did not lead to earlier reintervention when a patient did not undergo hysterectomy.