Importance: Suspension of the vaginal apex is the cornerstone of success in surgery for pelvic organ prolapse (POP).

Objective: We aimed to identify differences in surgeon subspecialty with respect to performing an apical suspension procedure verse an isolated anterior and/or posterior repair for the treatment of POP.

Study Design: This was a retrospective cohort study using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database to determine differences in surgeon subspecialty of women undergoing apical suspension procedures compared to isolated anterior and/or posterior repair for POP. Surgeries were identified using CPT codes. Sacrocolpopexy, uterosacral ligament suspension, and sacrospinous ligament suspension were defined as apical suspension surgeries. Non-apical suspension surgeries included isolated anterior and/or posterior repair. Obliterative surgeries were excluded. Surgeon subspecialty included Urogynecology and Reconstructive Pelvic Surgeons (URPS) and Obstetrics and Gynecology (OBG).

Results: 5,226 POP surgeries were performed which included 2,021 apical and 3,205 isolated anterior/posterior repairs. The majority of surgeries were performed by URPS (70.1%). Surgeon specialty differed significantly between cohorts (p<0.001). URPS were more likely to perform apical suspensions (78.6% vs 64.8%) compared to non-apical suspensions. OBG were more likely to perform non-apical suspensions (35.3% vs 21.4%). On multivariable logistic regression, patients who underwent apical suspension had an increased odd of having their surgery by a URPS (aOR 2.2, 95% CI 1.92-2.53) compared to an OBG.

Conclusions: Urogynecologists were more likely to perform apical suspension procedure at the time of POP repair than OBG, suggesting a possible advantage to have an URPS perform POP surgery.