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The impact of concomitant mid-urethral sling surgery on patients undergoing vaginal prolapse repair

Abstract

Introduction and hypothesis

The aim of this study was to assess whether mid-urethral sling (MUS) placement at the time of vaginal prolapse repair compared to vaginal prolapse repair alone is associated with an increase in 30-day postoperative complications.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Database, Current Procedural Terminology codes were used to identify cases of vaginal prolapse repair with and without concomitant MUS from 2012 to 2017. Student’s t-test and chi-square test were used to compare differences between the groups.

Results

A total of 1469 cases of vaginal prolapse repair with sling were compared to 4566 cases without sling. There was no difference between prolapse repair with sling compared to without sling in mean hospital length of stay (LOS) (1.42 versus 1.32 days, p = 0.65), postoperative urinary tract infection (UTI) (6.1% versus 5.8%, p = 0.670), perioperative blood transfusion (1.1% versus 1.2%, p = 0.673), readmission (2.7% versus 2.6%, p = 0.884) and postoperative wound infection (0.5% versus 0.7%, p = 0.51). There was a higher rate of reoperation (2.2% versus 1.5%, p = 0.049) and venous thromboembolism (VTE) (0.4% versus 0.1%, p = 0.030) in patients undergoing concomitant MUS compared to those undergoing prolapse repair alone.

Conclusions

Compared to prolapse repair alone, the addition of a sling did not increase hospital LOS, UTI, perioperative blood transfusions, readmission or postoperative wound infections. However, concomitant sling was found to be associated with a higher risk of reoperation and VTE.

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Fig. 1

Abbreviations

SUI:

Stress urinary incontinence

POP:

Pelvic organ prolapse

MUS:

Mid-urethral sling

FDA:

Food and Drug Administration

IRB:

Institutional Review Board

ACS NSQIP:

American College of Surgeons National Surgical Quality Improvement Database

CPT:

Current Procedural Terminology

UTI:

Urinary tract infection

VTE:

Venous thromboembolism

OPUS:

The Outcomes Following Vaginal Prolapse Repair and Mid-urethral Sling

FPMRS:

Female Pelvic Medicine and Reconstructive Surgery

CI:

Confidence interval

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Funding

This research was supported by New York University Langone Medical Center, New York, NY.

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Correspondence to Christina M. Escobar.

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Malacarne Pape, D., Escobar, C.M., Agrawal, S. et al. The impact of concomitant mid-urethral sling surgery on patients undergoing vaginal prolapse repair. Int Urogynecol J 32, 681–685 (2021). https://doi.org/10.1007/s00192-020-04544-6

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Keywords

  • Hospital surgical quality measures
  • Mid-urethral sling
  • NSQIP
  • Stress incontinence
  • Vaginal prolapse repair