Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery

  • Vibeke Weltz
  • Rikke Guldberg
  • Michael D. Larsen
  • Bjarne Magnussen
  • Gunnar Lose
Original Article
  • 17 Downloads

Abstract

Introduction and hypothesis

The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery.

Methods

Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period.

Results

During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25–30, 16.9% had BMI 30–35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6–2.3) and after 5 years 2.4% (CI 95%: 2.0–2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6–6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0–7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89–3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92–4.09).

Conclusions

We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.

Keywords

Urinary incontinence Sling surgery Body mass index Patient reported outcomes Subjective improvement Reoperation Mesh 

Abbreviations

BMI

Body mass index

DugaBase

The National Danish Urogynaecological Database

ICI

The International Consultation on Incontinence

ICI-Q

International Consultation on Incontinence Questionnaire

ICIQ-SF

International Consultation on Incontinence Questionnaire Short Form

MUS

Mid-urethral sling

NPR

Danish National Patient Registry

PGI-I

Patient Global Impression of Improvement

PROM

Patient Reported Outcome Measures

PHA

Public Health Notification

SUI

Stress urinary incontinence

US FDA

United States Food and Drug Administration

VAS

Visual analogue scales

WHO

World Health Organization

Notes

Acknowledgements

The study was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation.

Compliance with ethical standards

Conflicts of interest

Dr Weltz had travel expenses paid for by Astellas for EUGA Congress 2016. Dr Guldberg has accepted grants from Astellas and Pierre Fabre, Dr Lose has accepted payment for research from Astellas and worked as a consultant for Contura. The remaining authors claim that they have no conflicts of interest.

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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyHerlev University HospitalHerlevDenmark
  2. 2.Department of Obstetrics and GynaecologyAarhus University HospitalAarhusDenmark
  3. 3.Research Unit of Clinical Epidemiology, Institute of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark

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