The Impact of Surgical Center Volume on Reoperation Risk After Midurethral Sling.

To determine whether a center's surgical volume affects patient reoperation rates after midurethral sling surgery.

We performed a retrospective cohort study evaluating a large managed care organization from 2005 to 2016. The primary outcome was the MUS reoperation rate. Perioperative factors and reoperation of patients were compared using Wilcoxon rank sum for continuous variables and chi-square for categorical variables. We estimated the adjusted hazard ratio and the 95% confidence interval of reoperation using Cox proportional hazards model.

Within the managed care system, 13,404 primary MUS were performed at 11 centers over the study period (19/105 center years were considered low volume). Higher-volume centers (>58 procedures/year based on concentration curve) performed 93% of surgeries in this cohort. Overall reoperation risk for patients of higher-volume centers was smaller than those of lower-volume centers, 4.9% vs. 9.8% at 9 years (hazard ratio 0.45 (p <0.01)). Risk of reoperation for recurrent stress urinary incontinence (SUI) for patients was lower in the higher-volume centers, 4% vs. 9.1% at 9 years (p <0.01). Patient of higher-volume centers were less likely to have a reoperation for mesh exposure 0.2% vs. 0.7% (p <0.01) or infection 0% vs. 0.2% (p <0.01).

Patients who had their MUS surgery at a higher-volume medical center were less likely to have any reoperation including for recurrent SUI, mesh exposure, or infection. These findings persisted even when controlling for potential covariates including patient demographics and surgeon volume and specialty.

The Journal of urology. 2021 Jul 21 [Epub ahead of print]

Alexander A Berger, Jasmine Tan-Kim, Shawn A Menefee

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Franciscoe, San Diego, California., Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, Kaiser Permanente, San Diego, California.