Effect of procedure type and use of mesh on complications after surgery for pelvic organ prolapse: a retrospective cohort study

Abstract

BackgroundConcerns have been raised about the safety of surgery for pelvic organ prolapse using synthetic mesh. We aimed to assess complication rates in similar procedures with and without mesh. MethodsWith routine hospital discharge data for Scotland, 1997–2014, we identified index pelvic organ prolapse procedures using previously validated coding. Multiple and repeat procedures were excluded. Mesh and non-mesh procedures were compared for anterior colporrhaphy, posterior colporrhaphy, and vaginal suspension using a vaginal approach. Primary outcomes were immediate postoperative complications during index hospital admission, admission within 5 years for later postoperative complications, and admission within 5 years for further surgery for pelvic organ prolapse or stress urinary incontinence. Poisson regression (for count data) was adjusted for age, deprivation, comorbidity, hospital type, and surgeon volume. Findings18 614 women (median age 61 years, IQR 53–69) underwent a first single pelvic organ prolapse procedure during 1997–2014 with 1648 (9%) of procedures using mesh. The dataset was complete apart from 148 patients (0·8%) with missing deprivation data. Analysis showed these to be similar to those without missing data and they were excluded from analyses. There were no statistically significant differences in rates of immediate complications between mesh procedures and their non-mesh comparators. Later postoperative complications were more common for both anterior and posterior colporrhaphies with mesh than with their non-mesh equivalent (adjusted incident rate ratio [IRR] 2·80 [95% CI 2·14–3·68] vs 3·23 [2·38–4·38], both p<0·0001). Further surgery for stress urinary incontinence or pelvic organ prolapse was more common for anterior and posterior colporrhaphies with mesh than with their non-mesh equivalent (adjusted IRR 1·89 [95% CI 1·51–2·37], p<0·0001 vs 1·35 [0·96–1·89], p=0·083). The risk of later complications or further surgery after vaginal suspension with mesh was similar to that after equivalent non-mesh surgery. InterpretationThere were substantially higher rates of complications among patients undergoing mesh compared with non-mesh surgery for pelvic organ prolapse. This is the first study to our knowledge to compare mesh complication rates for similar procedures. These findings add to a growing body of evidence that mesh use in surgery for pelvic organ prolapse needs to be carefully considered and patients adequately counselled about potential risks and benefits. FundingNone.