MP10-17 SURGEON EXPERIENCE AND TRANSVAGINAL PROLAPSE MESH COMPLICATIONS

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2016MP10-17 SURGEON EXPERIENCE AND TRANSVAGINAL PROLAPSE MESH COMPLICATIONS Blayne Welk, Erin Kelly, and Jennifer Winick-Ng Blayne WelkBlayne Welk More articles by this author , Erin KellyErin Kelly More articles by this author , and Jennifer Winick-NgJennifer Winick-Ng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2347AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Warnings related to transvaginal mesh have been issued by the United States FDA and Health Canada. The objective of this study was to assess the impact of surgeon experience on vaginal prolapse mesh complications, and to determine if there are risk factors associated with vaginal mesh complications. METHODS We conducted a retrospective, population-based study using administrative data. We included all women who underwent a mesh based transvaginal prolapse procedure between 2002-2013 in Ontario, Canada. Our primary outcome was surgical revision/removal of the mesh. Our primary exposure was surgeon volume: high volume surgeons were defined as >90th percentile. Other covariates included age, obesity, diabetes, health care utilization, comorbidity, socioeconomic status, surgical specialty, prior/simultaneous pelvic surgical procedures, length of stay, and blood transfusion. Primary analysis was an adjusted Cox proportional hazards model. RESULTS We identified 5,488 women who underwent transvaginal mesh implantation for pelvic organ prolapse by 1 of 368 unique surgeons. Patients had a median followup of 5.4 (IQR 2.9-8.0) years. The cut-off for being defined as a high volume surgeon (90th percentile) was 13 procedures/year. 218 women (4.0%) underwent surgical revision of vaginal mesh a median of 1.17 (IQR 0.58-1.17) years after implantation. At 10 years followup the cumulative incidence of mesh removal was 5.0%. There was a higher probability of a surgical intervention for vaginal mesh complications with non-high volume surgeons (adjusted HR of 1.70 (95% CI 1.16-2.50). In multivariable modeling, intra/post-operative blood transfusion at the time of mesh implantation (HR 3.70, 95% CI 1.96-6.98), and increased medical comorbidity (HR 1.30, 95% CI 1.08-1.56) were significantly associated with future vaginal mesh revision. CONCLUSIONS After 10 years of followup, 1/20 women had surgical revision of vaginally placed prolapse mesh. There is a significantly lower risk of these complications among surgeons providing the highest volume of these procedures. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e108-e109 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Blayne Welk More articles by this author Erin Kelly More articles by this author Jennifer Winick-Ng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...