MP33-02 ARE CARE SEEKING PATTERNS DIFFERENT IN WOMEN REQUIRING A REPEAT PELVIC ORGAN PROLAPSE SURGERY DUE TO NATIVE TISSUE REPAIR FAILURE VERSUS A MESH COMPLICATION?

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2018MP33-02 ARE CARE SEEKING PATTERNS DIFFERENT IN WOMEN REQUIRING A REPEAT PELVIC ORGAN PROLAPSE SURGERY DUE TO NATIVE TISSUE REPAIR FAILURE VERSUS A MESH COMPLICATION? Kai Dallas, Lisa Rogo-Gupta, and Christopher Elliot Kai DallasKai Dallas More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta More articles by this author , and Christopher ElliotChristopher Elliot More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1073AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a limited understanding of care seeking patterns of women undergoing repeat surgery after Pelvic Organ Prolapse Repair (due to native tissue repair failure or a mesh complication). We hypothesized that undergoing repeat surgery for a mesh complication would be associated with migration to a new facility for care (potentially driven by the controversial nature of mesh use for POP repair, and the complexity of surgery for mesh complications). METHODS Using data from the Office of Statewide Health Planning and Development (OSHPD) for the state of California (2005-2011), all females who underwent an index POP repair procedure (with or without mesh) at non-federal facilities who subsequently underwent a repeat surgery (recurrent prolapse repair or for mesh complication) were identified. The location of index repair and repeat surgery was identified and factors associated with migration were explored. RESULTS Of the 3,930 women who underwent repeat surgery for either POP recurrence or a mesh complication, 1,331 (33.9%) had surgery at a new facility. Multivariate analysis revealed that index surgery at a non-high volume facility in a county with multiple competing facilities (odds 1.33, p<0.001), a mesh complication (odds 1.28, p=0.004) and same compartment recurrence (odds 1.19, p=0.02) were all associated with increased odds of seeking a new facility for further care. The effect of mesh complication and same compartment recurrence were not significantly different (figure 1a). Having surgery at a high-volume facility in a county with multiple competing facilities was associated with a decreased odds of seeking a new facility (odds 0.32, p<0.001) (Figure 1a). Whether for a mesh complication or native tissue repair failure, patients tended to migrate towards select centers in urban areas (Figure 1b,c). CONCLUSIONS Contrary to our hypothesis that mesh specific complications would be associated with an increased incidence of migration, women with native tissue failure have similar migration patterns. This suggests that the factors driving patient migration (physician referral for complexity, patient satisfaction) are similar for both a mesh complication and native tissue repair failure. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e428 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kai Dallas More articles by this author Lisa Rogo-Gupta More articles by this author Christopher Elliot More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...