Military Surgeon Volume and Stress Incontinence Surgery Complications-a Retrospective Cohort Study

To compare 12-month post-operative complication rates in women who underwent sling procedures by high-volume versus low-volume surgeons at US military treatment facilities (MTFs).

Retrospective cohort study (Canadian Task Force classification II-2) SETTING: US military treatment facilities PATIENTS: Female military beneficiaries enrolled in TRICARE INTERVENTIONS: Sling surgery for stress urinary incontinence (SUI) between January 1, 2011, and December 31, 2012.

The primary exposure was surgeon volume (high versus low). Surgeon volume was categorized as high or low based on the number of slings performed in the previous 2 years at US MTFs (January 1, 2009, to December 31, 2010). The primary outcome was a composite variable indicating at least 1 post-operative complication within 12 months. We used ICD-9 and CPT codes to identify post-operative complications that occurred in the 12 months following the index sling procedure. During the study period, 348 gynecologic and urologic surgeons performed 1,632 slings. The average patient age was 47.2 years. Based on our data distribution, we classified surgeons as high-volume (>12 slings/2 years) or low-volume (<4 slings/2 years). High-volume surgeons operated on patients who were older, more likely to have comorbidities, and more likely to receive concomitant prolapse surgery. Using a cluster analysis, the overall likelihood of at least 1 post-operative complication in 12 months for high-volume versus low-volume surgeons was 48.4% versus 42.2% (adjusted OR [95% CI]=1.24 [0.99-1.54], p=.06). There were no differences between high- and low-volume surgeons in the rate of almost all other post-operative complications.

No significant differences in 12-month complication rates after sling surgery, stratified by surgeon volume, were seen in a setting of overall low-volume military surgeons.

Journal of minimally invasive gynecology. 2018 Jan 11 [Epub ahead of print]

David L Howard, Andrea McGlynn, Joy A Greer

633rd Medical Group, Joint Base Langley-Eustis. Electronic address: ., Clinical Investigation Department, Naval Medical Center., Women's Health Department, Division of Urogynecology, Naval Medical Center.