30 Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8,772 Cases Using a National Prospective Database

To determine 30 day complications, risk of readmission, and reoperation for midurethral slings(MUS).

The National Surgical Quality Improvement Program database from 2006-2013 was queried for MUS alone by excluding concurrent reconstructive, urologic, or gynecologic procedures. We assessed baseline characteristics, 30-day perioperative outcomes and 30-day readmission. Logistic regression analysis identified risk factors for the frequent complications.

8772 women underwent MUS, of which 3830 (43.7%) and 4942 (56.3%) were performed by urologists and gynecologists, respectively. Patients of urologists were older, had higher frailty, and were more likely diabetic (all p<0.05). Patients of gynecologists were more likely to have resident involvement compared to urologists (16.4% vs. 11.2%,p<0.001). Mean operative time was shorter for urologists compared to gynecologists (35.6 +/- 29.2 vs 38.1 +/- 34.3 min,p<0.001). The overall 30-day rate of any complication was 3.52%. Urinary tract infection (UTI) occurred in 2.2% vs. 3.5% of the urologic and gynecologic patients, respectively (p=0.001). After adjusting for frailty, BMI, steroid use, age, operative time and residency involvement, gynecologic performed surgery incurred an increased risk of UTI (OR:1.67,95%CI:1.27-2.19;p=0.001). Sixty five (0.90%) patients were readmitted within 30 days, most commonly due to urinary symptoms. Sling revision for urinary obstruction occurred in 15 patients; 10 underwent repair of the bladder, urethra, or vagina.

To our knowledge, we present the largest American cohort of MUS 30-day outcomes to date stratified by specialty of performing surgeon. Overall, morbidity is low. UTI is the most common complication, and occurs at increased frequency for patients of gynecologists.

Urology. 2016 May 16 [Epub ahead of print]

Andrew J Cohen, Vignesh T Packiam, Charles U Nottingham, Blake D Alberts, Sarah F Faris, Gregory T Bales

Department of Surgery, Section of Urology, University of Chicago Medicine, 5841 S. Maryland Ave. MC 6038, Chicago, IL, 60637, Office: 773-702-1000, Fax: 773-702-1001. Electronic address: ., Department of Surgery, Section of Urology, University of Chicago Medicine, 5841 S. Maryland Ave. MC 6038, Chicago, IL, 60637, Office: 773-702-1000, Fax: 773-702-1001., Department of Surgery, Section of Urology, University of Chicago Medicine, 5841 S. Maryland Ave. MC 6038, Chicago, IL, 60637, Office: 773-702-1000, Fax: 773-702-1001., Department of Surgery, Section of Urology, University of Chicago Medicine, 5841 S. Maryland Ave. MC 6038, Chicago, IL, 60637, Office: 773-702-1000, Fax: 773-702-1001., Department of Surgery, Section of Urology, University of Chicago Medicine, 5841 S. Maryland Ave. MC 6038, Chicago, IL, 60637, Office: 773-702-1000, Fax: 773-702-1001., Department of Surgery, Section of Urology, University of Chicago Medicine, 5841 S. Maryland Ave. MC 6038, Chicago, IL, 60637, Office: 773-702-1000, Fax: 773-702-1001.

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