The Colpopexy and Urinary Reduction Efforts (CARE) trial—Has it changed practice patterns in the state of New York?

Chen A1, Tam J1, Siegal A1, Gross M1, Kim J1, Weissbart S1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 147
Female Lower Urinary Tract Symptoms
Scientific Podium Short Oral Session 10
On-Demand
Female Pelvic Organ Prolapse Prolapse Symptoms Surgery Stress Urinary Incontinence
1. Stony Brook University Hospital
Presenter
A

Annie Chen

Links

Abstract

Hypothesis / aims of study
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.
Study design, materials and methods
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.
Results
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.
Interpretation of results
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.
Concluding message
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.
Figure 1
References
  1. 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
  2. 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
  3. 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
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Institutional Review Board Helsinki Yes Informed Consent No
27/03/2024 14:42:08