Objective
The aim of this study was to estimate the number of women undergoing ambulatory surgical procedures for female pelvic floor disorders (PFDs) in the United States and to compare age-adjusted ambulatory surgical case rates between 1996 and 2006.
Study Design
We analyzed data from the 1996 and 2006 National Survey of Ambulatory Surgery, a federal public access deidentified database. Procedures for PFDs were identified using International Classification of Diseases-9th revision Clinical Modification procedure codes for urinary incontinence, fecal incontinence, and pelvic organ prolapse.
Results
The number of women undergoing ambulatory surgical procedures for urinary incontinence increased from 34,968 (95% confidence interval, 25,583–44,353) in 1996 to 105,656 (95% confidence interval, 79,033–132,279) in 2006. The age-adjusted ambulatory surgical case rates for all PFDs increased from 7.91 per 10,000 in 1996 to 12.10 per 10,000 in 2006 ( P = .0006).
Conclusion
Ambulatory procedures for urinary incontinence increased between 1996 and 2006, as well as the age-adjusted ambulatory case rate for all PFDs.
Pelvic floor disorders (PFDs) is a general term for diseases of the pelvic floor caused by defects in the muscles or support structures of the pelvis. PFDs include urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP). PFDs are common. The prevalence of these disorders among community-dwelling women over the age of 20 years in the United States is estimated to be 15.7% for UI, 9.0% for FI, and 2.9% for symptomatic POP.
Although conservative options exist, for many women, the treatment of PFDs is surgical. A woman’s lifetime risk of undergoing a procedure for UI or POP by the age of 80 years is estimated to be 11%. Analysis of the National Hospital Discharge Summary (NHDS) estimated that more than 200,000 and 100,000 inpatient surgical procedures are performed in the United States annually for POP and female UI, respectively. Unfortunately, these estimates do not include ambulatory surgical procedures.
The National Survey of Ambulatory Surgery (NSAS) was conducted in 1994, 1995, and 1996. In 2003, Boyles et al reported the rates of UI ambulatory procedures for these years. After a 10-year hiatus, the NSAS survey was conducted again in 2006. The objective of this study was (1) to estimate the number of women undergoing ambulatory surgical procedures for female PFDs in the United States, (2) to compare the proportion of ambulatory surgical visits for PFDs with all ambulatory surgical visits, and (3) to compare age-adjusted ambulatory surgical case rates for PFDs between 1996 and 2006.
Materials and Methods
We analyzed data from the 1996 and 2006 NSAS, a federal public access deidentified database. The NSAS was conducted in 1994, 1995, 1996, and 2006 to capture information on ambulatory surgeries. The 2006 NSAS database was originally released Jan. 4, 2009; however, errors in the dataset prompted the database to be removed and revised. The revised dataset was released in August 2009. We analyzed the revised 2006 dataset, which was downloaded from the National Center of Healthcare Statistics (NCHS) website on Aug. 18, 2009.
NSAS covers ambulatory procedures performed at both hospitals and free-standing centers. Ambulatory procedures in the survey include procedures performed in general operating rooms, dedicated ambulatory surgery rooms, or other specialized rooms, such as endoscopy or cardiac catheterization suites. The NSAS does not report on nonsurgical ambulatory visits or procedures performed in either physicians’ offices or emergency departments. NSAS is the principal source for data on ambulatory procedures performed in the United States.
The NSAS samples facilities using a multistage probability design. The 1996 NSAS survey included 323 hospitals and 277 free-standing ambulatory surgery centers. The 2006 NSAS survey included 189 hospitals and 398 free-standing ambulatory surgery centers. The response rate for eligible hospitals and free-standing centers invited to participate in the NSAS was 70% and 91% for 1996 and 74% and 76% for 2006. The 1996 and 2006 NSAS datasets included approximately 125,000 records corresponding to approximately 21.2 million visits and 52,000 records corresponding to approximately 34.7 millions visits, respectively. Both the absolute number of ambulatory surgical visits and the number of free-standing ambulatory surgical centers in the United States grew between 1996 and 2006. Additional details about the NSAS can be found at http://www.cdc.gov/nchs/nsas/about_nsas.htm .
This study was exempt from review by the institutional review board. Exemption was verified in writing from both the Yale Human Investigation Committee (HIC) and Women and Infants Hospital of Rhode Island’s Institutional Review Board.
We defined ambulatory procedures for PFDs based on the International Classification of Diseases-9th Clinical Modification revision (ICD-9-CM) procedure codes for UI, FI, and POP. A complete list of the procedure coded in the dataset can be found in Table 1 . Not all queried codes had procedures listed in the dataset. A list of queried codes not in the dataset is provided in the footnote to the table . Although both ICD-9-CM diagnosis codes and CPT codes have changed over the last 15 years, the ICD-9-CM procedure codes for PFDs remained constant between 1996 and 2006. We verified this by confirming ICD-9-CM code changes and revisions with the code conversion tables published by the National Center for Health Statistics. Up to 6 ICD-9-CM procedure codes, representing concomitant procedures, were recorded in the NSAS per ambulatory surgical visit in both the 1996 and 2006 datasets.
| Procedure | ICD-9-CM procedure code |
|---|---|
| Urinary incontinence | |
| Cystourethroplasty and repair of bladder neck | 57.85 |
| Cystopexy NOS | 57.89 |
| Plication of the urethrovesical junction | 59.3 |
| Suprapubic sling operation | 59.4 |
| Retropubic urethral suspension | 59.5 |
| Paraurethral suspension | 59.6 |
| Levator muscle operation (pubococcygeal sling) | 59.71 |
| Injection of implant (urethral bulking agent) | 59.72 |
| Other repair of stress urinary incontinence | 59.79 |
| Fecal incontinence | |
| Repair of old obstetric laceration of the anus | 49.79 |
| Pelvic organ prolapse | |
| Vaginal hysterectomy with repair of pelvic floor | 68.5 |
| Uterine suspension | 69.22 |
| Obliteration of the vagina | 70.4 |
| Cystocele and rectocele repair | 70.5 |
| Cystocele repair | 70.51 |
| Rectocele repair | 70.52 |
| Vaginal reconstruction | 70.62 |
| Vaginal suspension and fixation | 70.77 |
| Repair of pelvic floor | 70.79 |
| Le Fort operation | 70.8 |
| Other operations or repair of the vagina | 70.91 |
| Repair of vaginal enterocele | 70.92 |
| Repair of old obstetric laceration of the perineum | 71.79 |
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