Dataset Information

Patient's preference for sacrospinous hysteropexy or modified Manchester operation: A discrete choice experiment.

ABSTRACT:

Objective

To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse.

Design

Labelled discrete choice experiment (DCE).

Setting

Eight Dutch hospitals.

Population

Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation.

Methods

DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success ( levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models.

Main outcome measures

Women's preference for MM or SH.

Results

137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision-making. For SH, all attributes were relevant for decision-making.

Conclusions

The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare.

SUBMITTER: Schulten SFM

PROVIDER: S-EPMC10087824 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Patient's preference for sacrospinous hysteropexy or modified Manchester operation: A discrete choice experiment.

Schulten Sascha F M SFM Essers Brigitte B Notten Kim J B KJB Enklaar Rosa A RA van Leijsen Sanne A L SAL van Eijndhoven Hugo W F HWF Kluivers Kirsten B KB Weemhoff Mirjam M

BJOG : an international journal of obstetrics and gynaecology 20220831 1

<h4>Objective</h4>To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse.<h4>Design</h4>Labelled discrete choice experiment (DCE).<h4>Setting</h4>Eight Dutch hospitals.<h4>Population</h4>Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation.<h4>Methods</h4>DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatmen ...[more]

PMID: 36043332

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Project description:ImportanceIn many countries, sacrospinous hysteropexy is the most commonly practiced uterus-preserving technique in women undergoing a first operation for pelvic organ prolapse. However, there are no direct comparisons of outcomes after sacrospinous hysteropexy vs an older technique, the Manchester procedure.ObjectiveTo compare success of sacrospinous hysteropexy vs the Manchester procedure for the surgical treatment of uterine descent.Design, setting, and participantsMulticenter, noninferiority randomized clinical trial conducted in 26 hospitals in the Netherlands among 434 adult patients undergoing a first surgical treatment for uterine descent that did not protrude beyond the hymen.InterventionsParticipants were randomly assigned to undergo sacrospinous hysteropexy (n = 217) or Manchester procedure (n = 217).Main outcomes and measuresThe primary outcome was a composite outcome of success, defined as absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by a standardized vaginal support quantification system, absence of bothersome bulge symptoms, and absence of prolapse retreatment (pessary or surgery) within 2 years after the operation. The predefined noninferiority margin was 9%. Secondary outcomes were anatomical and patient-reported outcomes, perioperative parameters, and surgery-related complications.ResultsAmong 393 participants included in the as-randomized analysis (mean age, 61.7 years [SD, 9.1 years]), 151 of 196 (77.0%) in the sacrospinous hysteropexy group and 172 of 197 (87.3%) in the Manchester procedure group achieved the composite outcome of success. Sacrospinous hysteropexy did not meet the noninferiority criterion of -9% for the lower limit of the CI (risk difference, -10.3%; 95% CI, -17.8% to -2.8%; P = .63 for noninferiority). At 2-year follow-up, perioperative outcomes and patient-reported outcomes did not differ between the 2 groups.ConclusionsBased on the composite outcome of surgical success 2 years after primary uterus-sparing pelvic organ prolapse surgery for uterine descent, these results support a finding that sacrospinous hysteropexy is inferior to the Manchester procedure.Trial registrationTrialRegister.nl Identifier: NTR 6978.

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Dataset Information

Patient's preference for sacrospinous hysteropexy or modified Manchester operation: A discrete choice experiment.

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusions

Publications

Patient's preference for sacrospinous hysteropexy or modified Manchester operation: A discrete choice experiment.

Similar Datasets

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