1544 SHORT-TERM OUTCOMES OF VAGINAL MESH PLACEMENT AMONG FEMALE MEDICARE BENEFICIARIES

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 20121544 SHORT-TERM OUTCOMES OF VAGINAL MESH PLACEMENT AMONG FEMALE MEDICARE BENEFICIARIES Jennifer Anger, Aqsa Khan, Karyn Eilber, Stephanie Histed, Ning Wu, Chris L. Pashos, and J. Quentin Clemens Jennifer AngerJennifer Anger Los Angeles, CA More articles by this author , Aqsa KhanAqsa Khan Los Angeles, CA More articles by this author , Karyn EilberKaryn Eilber Los Angeles, CA More articles by this author , Stephanie HistedStephanie Histed Los Angeles, CA More articles by this author , Ning WuNing Wu Lexington, MA More articles by this author , Chris L. PashosChris L. Pashos Lexington, MA More articles by this author , and J. Quentin ClemensJ. Quentin Clemens Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1314AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mesh in the surgical treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) has gained wide popularity in the past decade, with a concurrent increase in mesh related complications. Mesh-associated morbidity led to FDA warnings in October 2008 and July 2011 against transvaginal mesh placement for POP and SUI. We used a national dataset to compare short-term outcomes between prolapse repairs with and without mesh. METHODS Data were obtained from the Centers for Medicare and Medicaid Services Public Use Files for a 5% national random sample of female Medicare beneficiaries age 65 and over. Women who had prolapse surgery were identified by Current Procedural Terminology Coding System (CPT-4) codes. Since the CPT-4 code for mesh placement was effected in 2005, patients were separated into those who underwent prolapse repairs in 1999-2000 (without mesh) and those who had repairs with mesh in 2007-2008. Outcomes of surgery up to one year were identified using ICD-9 diagnosis codes and CPT-4 procedure codes for complications and early reoperations for POP. Subset analysis was performed to analyze outcomes related to concomitant sling surgery. RESULTS 9,180 prolapse repairs were performed during the 1999-2000 period, including 1,484 with concomitant sling. 1,804 prolapse repairs with a code for mesh were performed in 2007-2008, including 870 with concomitant sling. The need for further prolapse treatment including pessary use and reoperations was higher in the non-mesh vs. mesh cohort (Table). Mesh removal rates increased from 0.0% in both non-mesh groups to 3.3% in the mesh group. Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling. Outcome, No. (%) WITHOUT MESH (1999-2000) WITH MESH (2007-2008) p value WITHOUT MESH (2007-2008) WITH MESH (2007-2008) p value Pessary 17% 2% < 0.001 20% 2% < 0.001 Any repeat prolapse surgery 7% 4% < 0.001 6% 4% < 0.020 Mesh Removal 0% 3% < 0.001 0% 3% < 0.001 Bleeding 23% 27% < 0.001 28% 27% 0.860 Urinary Tract Infection 34% 41% < 0.001 38% 41% < 0.020 Dyspareunia (code 625) 19% 27% < 0.001 19% 27% < 0.001 Urinary Retention 9% 17% < 0.001 13% 17% < 0.001 Mechanical Device Complication 1% 5% < 0.001 1% 5% < 0.001 CONCLUSIONS Mesh placement to treat POP and SUI was associated with a decrease in early prolapse recurrence. However, use of mesh was associated with an increased rate of pain, retention, mechanical mesh-related complications and associated mesh removal procedures. Long-term data is needed to determine whether the short-term decrease in early reoperations translates into better long-term durability with mesh. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e625 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Anger Los Angeles, CA More articles by this author Aqsa Khan Los Angeles, CA More articles by this author Karyn Eilber Los Angeles, CA More articles by this author Stephanie Histed Los Angeles, CA More articles by this author Ning Wu Lexington, MA More articles by this author Chris L. Pashos Lexington, MA More articles by this author J. Quentin Clemens Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...