30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective Database

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

Research output: Contribution to journalArticle

Abstract

Objective To determine 30-day complications, risk of readmission, and reoperation for midurethral slings (MUS). Methods The National Surgical Quality Improvement Program database from 2006 to 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. Results There were 8772 women who 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 < .05). Patients of gynecologists were more likely to have resident involvement compared to urologists (16.4% vs 11.2%, P < .001). Mean operative time was shorter for urologists compared to gynecologists (35.6 ± 29.2 minutes vs 38.1 ± 34.3 minutes, P < .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 = .001). After adjusting for frailty, body mass index, 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 = .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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)72-79
Number of pages8
JournalUrology
Volume95
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

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Suburethral Slings
Reoperation
Databases
Morbidity
Urinary Tract Infections
Operative Time
Gynecologic Surgical Procedures
Vagina
Urethra
Internship and Residency
Quality Improvement
Urinary Bladder
Body Mass Index
Logistic Models
Steroids
Regression Analysis
Urologists

ASJC Scopus subject areas

  • Urology

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30-Day Morbidity and Reoperation Following Midurethral Sling : Analysis of 8772 Cases Using a National Prospective Database. / Cohen, Andrew J.; Packiam, Vignesh T.; Nottingham, Charles U.; Alberts, Blake D.; Faris, Sarah F.; Bales, Gregory T.

In: Urology, Vol. 95, 01.09.2016, p. 72-79.

Research output: Contribution to journalArticle

Cohen, Andrew J. ; Packiam, Vignesh T. ; Nottingham, Charles U. ; Alberts, Blake D. ; Faris, Sarah F. ; Bales, Gregory T. / 30-Day Morbidity and Reoperation Following Midurethral Sling : Analysis of 8772 Cases Using a National Prospective Database. In: Urology. 2016 ; Vol. 95. pp. 72-79.
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abstract = "Objective To determine 30-day complications, risk of readmission, and reoperation for midurethral slings (MUS). Methods The National Surgical Quality Improvement Program database from 2006 to 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. Results There were 8772 women who 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 < .05). Patients of gynecologists were more likely to have resident involvement compared to urologists (16.4{\%} vs 11.2{\%}, P < .001). Mean operative time was shorter for urologists compared to gynecologists (35.6 ± 29.2 minutes vs 38.1 ± 34.3 minutes, P < .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 = .001). After adjusting for frailty, body mass index, 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 = .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. Conclusion 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.",
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T1 - 30-Day Morbidity and Reoperation Following Midurethral Sling

T2 - Analysis of 8772 Cases Using a National Prospective Database

AU - Cohen, Andrew J.

AU - Packiam, Vignesh T.

AU - Nottingham, Charles U.

AU - Alberts, Blake D.

AU - Faris, Sarah F.

AU - Bales, Gregory T.

PY - 2016/9/1

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N2 - Objective To determine 30-day complications, risk of readmission, and reoperation for midurethral slings (MUS). Methods The National Surgical Quality Improvement Program database from 2006 to 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. Results There were 8772 women who 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 < .05). Patients of gynecologists were more likely to have resident involvement compared to urologists (16.4% vs 11.2%, P < .001). Mean operative time was shorter for urologists compared to gynecologists (35.6 ± 29.2 minutes vs 38.1 ± 34.3 minutes, P < .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 = .001). After adjusting for frailty, body mass index, 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 = .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. Conclusion 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.

AB - Objective To determine 30-day complications, risk of readmission, and reoperation for midurethral slings (MUS). Methods The National Surgical Quality Improvement Program database from 2006 to 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. Results There were 8772 women who 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 < .05). Patients of gynecologists were more likely to have resident involvement compared to urologists (16.4% vs 11.2%, P < .001). Mean operative time was shorter for urologists compared to gynecologists (35.6 ± 29.2 minutes vs 38.1 ± 34.3 minutes, P < .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 = .001). After adjusting for frailty, body mass index, 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 = .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. Conclusion 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.

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