National Surgical Trends and Perioperative Outcomes of Mid-Urethral Sling Placement for Stress Urinary Incontinence

To determine contemporary trends, patient characteristics, and outcomes for mid-urethral sling placement (MUS) at inpatient and ambulatory facilities from a national database.

Using the American College of Surgeons National Surgical Quality Improvement Program data base, we identified 7,767 women who underwent isolated MUS 2006-2012. We stratified patients by hospitalization type (outpatient vs. hospitalization). Primary outcomes were 30-day complications, readmissions, and reoperations. Multivariable logistic regression was used to determine patient and surgery factors associated with adverse perioperative outcomes.

Among the 7,767 women undergoing MUS, 84.3% underwent outpatient surgery (n=6,547), with greater use of outpatient facilities over time (p<0.001). Overall, 3.9% of patients (n=300) experienced one or more postoperative complications. Complications were more likely among inpatients (7.4% vs. 3.2%; OR 0.48, CI 0.36-0.64, p<0.001), with gynecologists as compared to urologists (4.4% vs. 3.1%; OR 1.53, CI 1.16-2.02, p=0.003), and with resident participation (5.1% vs. 3.7%; OR 1.32, CI 1.01-1.73, p=0.04). On multivariable analysis, outpatients were less likely to experience readmissions (0.9% vs. 2.8%; OR 0.2, CI 0.09-0.56, p=0.002) or undergo reoperation (0.3% vs. 3.1%; OR 0.10, CI 0.02-0.38, p=0.001).

Use of outpatient surgical centers for MUS is increasing, with lower rates of complications, readmissions and reoperations compared to inpatient treatment. While there is a difference in complications by specialty and with resident involvement, overall incidence of complications is low.

Urology. 2016 Sep 23 [Epub ahead of print]

Emily A Slopnick, Adonis K Hijaz, Carvell T Nguyen, Robert Abouassaly, Christopher M Gonzalez, Sangeeta T Mahajan, J Welles Henderson, Matthew J Bream, Simon P Kim

Division of Urology, MetroHealth Medical Center, Cleveland, OH., Urology Institute, University Hospitals Case Medical Center, Cleveland, OH., Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, University Hospitals Case Medical Center, Cleveland, OH., Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: .

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