National Surgical Trends and Perioperative Outcomes of Midurethral Sling Placement for Stress Urinary Incontinence. Journal Article

Local Library Link: Find It @ Loyola

Authors: Slopnick, EA; Hijaz, AK; Nguyen, CT; Abouassaly, R; Gonzalez, CM; Mahajan, ST; Henderson, JW; Bream, MJ; Kim, SP
Article Title: National Surgical Trends and Perioperative Outcomes of Midurethral Sling Placement for Stress Urinary Incontinence.
Abstract: OBJECTIVE: To determine contemporary trends, patient characteristics, and outcomes for midurethral sling placement (MUS) at inpatient and ambulatory facilities from a national database. MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 7767 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. RESULTS: Among the 7767 women undergoing MUS, 84.3% underwent outpatient surgery (n?=?6547), with greater use of outpatient facilities over time (P?.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%; odds ratio [OR] 0.48, confidence interval [CI] 0.36-0.64, P?.001), with gynecologists as compared to urologists (4.4% vs 3.1%; OR 1.53, CI 1.16-2.02, P?=?.003), and with resident participation (5.1% vs 3.7%; OR 1.32, CI 1.01-1.73, P?=?.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?=?.002) or undergo reoperation (0.3% vs 3.1%; OR 0.10, CI 0.02-0.38, P?=?.001). CONCLUSION: Use of outpatient surgical centers for MUS is increasing, with lower rates of complications, readmissions, and reoperations compared to inpatient treatment. Although there is a difference in complications by specialty and with resident involvement, overall incidence of complications is low.
Journal Title: Urology
ISSN: 1527-9995; 0090-4295
Publisher: Elsevier Inc  
Date Published: 2017