Surgical Management of Diastasis Recti: A Systematic Review of Insurance Coverage in the United States.

BACKGROUND: As elective surgery becomes more popular, the stringency of insurance coverage policies has increased exponentially. Many patients with diastasis recti (DR) are denied coverage of the corrective surgery that has been shown to improve function and quality of life in this patient population. Plastic surgeons are frustrated by the lack of guidelines and sparsity of coverage for surgical correction of DR. METHODS: Fifty-four US insurance companies and Medicare were reviewed to determine their policies of coverage. These policies were compared with the guidelines set forth by the American Society of Plastic surgery and current literature on DR. RESULTS: Insurance company policy for DR repair is not clear nor well established. Of the 55 policies reviewed in this study, 51 had an established policy. Forty of these companies would not cover abdominoplasty to repair DR under any circumstances. Eleven companies required preauthorization to ensure that the patient met the requirements of medical necessity. These requirements differed from company to company. A comprehensive list was compiled of details required for preauthorization. CONCLUSIONS: Insurance company policies do not recognize the spectrum of patients with DR and the necessity of abdominoplasty to relieve symptoms of patients with severe debilitation. The current Common Procedural Terminology coding classifies abdominoplasty to repair DR solely as a cosmetic procedure. Policies for DR repair should be amended to include a functional procedure reimbursement for severe DR and include detailed guidelines for coverage requirements to simplify the reimbursement process.

[Impact of the diastasis of the rectus abdominis muscles on the pelvic-perineal symptoms: Review of the literature]. / Impact du diastasis des muscles droits de l'abdomen sur les symptômes pelvi-périnéaux : revue de la littérature.

INTRODUCTION: The diastasis of the rectus abdominis muscles is common during pregnancy and post-partum. OBJECTIVE: To determine the prevalence of this pathology, methods of diagnosis, association with pelvic-perineal disorders and therapies that may be proposed. METHODS: Review of Pubmed, Medline, Embase and Cochrane literature using the following words and MeSH: diastasis, diastasis and pregnancy, diastasis of the rectus abdominis muscle, increase of the inter-recti distance. RESULTS: Among the 124 articles found, 61 were selected. Ultrasound seems to be the exam of choice both in terms of feasibility and reproducibility for the diagnosis of this pathology (intra-class correlation coefficients (ICC) high 0.81 to 0.94). The risk factors identified vary from one study to another: heavy load bearing (OR=2.18 (95 % CI 1.05 to 4.52) P=0.04), weight gain. Studies are discordant regarding the association between diastasis and low back pain (RR=1.39 (95 % CI 0.91-2.14), P=0.17), urinary incontinence (RR=0.86 (95 % CI 0.55-1.33) P>0.65) and prolapse (OR=2.25 (95 % CI 1.51-3.37) P<0.001), but the diastasis seems to play a role in the alteration of the quality of life for these patients. CONCLUSION: Knowledge about risk factors, consequences of diastasis and management is still limited today. It is therefore necessary to establish prospective studies on larger numbers in order to improve knowledge on the diastasis of the rectus abdominis muscles.

Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation.

STUDY DESIGN: Systematic literature review. BACKGROUND: Diastasis of the rectus abdominis muscle (DRAM) has been linked with low back pain, abdominal and pelvic dysfunction. Measurement is used to either screen or to monitor DRAM width. Determining which methods are suitable for screening and monitoring DRAM is of clinical value. OBJECTIVES: To identify the best methods to screen for DRAM presence and monitor DRAM width. METHODS: AMED, Embase, Medline, PubMed and CINAHL databases were searched for measurement property studies of DRAM measurement methods. Population characteristics, measurement methods/procedures and measurement information were extracted from included studies. Quality of all studies was evaluated using 'quality rating criteria'. When possible, reliability generalisation was conducted to provide combined reliability estimations. RESULTS: Thirteen studies evaluated measurement properties of the 'finger width'-method, tape measure, calipers, ultrasound, CT and MRI. Ultrasound was most evaluated. Methodological quality of these studies varied widely. Pearson's correlations of r = 0.66-0.79 were found between calipers and ultrasound measurements. Calipers and ultrasound had Intraclass Correlation Coefficients (ICC) of 0.78-0.97 for test-retest, inter- and intra-rater reliability. The 'finger width'-method had weighted Kappa's of 0.73-0.77 for test-retest reliability, but moderate agreement (63%; weighted Kappa = 0.53) between raters. Comparing calipers and ultrasound, low measurement error was found (above the umbilicus), and the methods had good agreement (83%; weighted Kappa = 0.66) for discriminative purposes. CONCLUSIONS: The available information support ultrasound and calipers as adequate methods to assess DRAM. For other methods limited measurement information of low to moderate quality is available and further evaluation of their measurement properties is required.