Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse

OBJECTIVES: To: 1) determine the proportion of hysterectomy cases with documentation of pessary counseling prior to prolapse surgery, and 2) identify variables associated with women offered a pessary. STUDY DESIGN: The Michigan Surgical Quality Collaborative (MSQC) is a hysterectomy improvement initiative. Hysterectomies from 2013-2015 in which prolapse was the principal diagnosis were included. "Pessary offer” was defined as documentation showing the patient declined, could not tolerate, or failed a pessary trial. Bivariate analyses were used to compare demographics, medical history, surgical route, concomitant procedures (colpopexy or colporrhaphy), as well as intra- and postoperative complications between women with and without pessary offer. Hierarchical logistic regression was used to determine factors independently associated with pessary offer. Risk-adjusted pessary offer rates by hospital were calculated. RESULTS: The adjusted rate of pessary offer was 25.2%, ranging from 3-76% per hospital. Bivariate comparisons showed differences between women with and without pessary offer in age, tobacco use, prior pelvic surgery, insurance status, surgical approach, secondary indication for surgery, concomitant prolapse procedure, teaching hospital status, and hospital bed size. In logistic regression, odds of pessary offer increased with age >55 (OR 1.45, 95% CI 1.12-1.88, p=.006), Medicare insurance (OR 1.65, 95% CI 1.30-2.10, p