Pelvic organ prolapse (POP) is an incredibly prevalent issue estimated to affect anywhere between 40-75% of adult women [1]. According to the AUA, POP is defined as the descent of either the anterior or posterior vaginal wall beyond the vaginal introitus secondary to weakness in the pelvic floor muscles involving the vagina, bladder, rectum, or small bowel. Repair of POP is performed in an estimated 10-20% of women with the abdominal sacrocolpopexy (SCP) as the gold standard operative intervention [2]. In 2006, the landmark Colpopexy and Urinary Reduction Efforts (CARE) trial demonstrated that in women without stress urinary incontinence, abdominal SCP with Burch colposuspension significantly reduced postoperative stress urinary incontinence [3]. The impact of a high quality evidence based studies such as the CARE trial on practice patterns is not well elucidated. We sought to investigate the effect of these findings on the use of abdominal SCP with or without an anti-incontinence procedure using a statewide database.

Institutional review board approval was obtained for a retrospective review of the NY Statewide Planning and Research Cooperative System (SPARCS) database. The SPARCS database was queried for inpatient procedures that describe SCP (ICD-9-CM 70.77 and 70.78), retropubic urethral suspension (ICD-9 CM 59.5), suprapubic sling procedures (ICD-9 CM 59.4), and other repair of stress urinary incontinence (ICD-9 CM 59.79). Data extracted from 5 years before the CARE trial (2001-2006) and 5 years after the CARE trial (2006-2011) were analyzed. Statistical analysis was performed using SPSS v26 and linear regression was performed to assess trends. Statistical significance was defined as p-value <0.05.

Over the 10-year study period, a total of 248,876 procedures for POP and stress urinary incontinence were identified. Of these, 71,340 SCP procedures and 140,888 anti-incontinence procedures including retropubic urethral suspension, suprapubic sling, and other repair of stress urinary incontinence were performed. There was a significant increase in the number of SCP with concomitant SUI procedures (r2=0.848, p <0.001) and SCP alone (r2=0.575, p=0.007) performed after publication of the CARE trial.

In New York State, there was a significantly positive correlation in the number of SCP performed with or without anti-incontinence procedures after the publication of the CARE trial when compared to prior to the CARE trial.

Of the numerous studies that become abstracts and manuscripts, an overwhelming amount of these studies do not affect change in the way physicians and providers practice. The CARE trial is an example of how evidence-based medicine translates into measurable changes in practice patterns. Future studies are needed to investigate the impact of the CARE trial on surgical outcomes.

Hendrix S. L., Clark A., Nygaard I., et al. (2002). Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol, 186(6), 1160-1166. doi:10.1067/mob.2002.123819
Nygaard I., Brubaker L., Zyczynski H. M., et al. (2013). Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. Jama, 309(19), 2016-2024. doi:10.1001/jama.2013.4919
Brubaker L., Cundiff G. W., Fine P., et al. (2006). Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med, 354(15), 1557-1566. doi:10.1056/NEJMoa054208