MP6-15 THE UTILIZATION OF MESH IN PROLAPSE AND INCONTINENCE SURGERY BEFORE AND AFTER THE 2008 FDA PUBLIC HEALTH NOTIFICATION IN A PRIVATE INSURER POPULATION

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-15 THE UTILIZATION OF MESH IN PROLAPSE AND INCONTINENCE SURGERY BEFORE AND AFTER THE 2008 FDA PUBLIC HEALTH NOTIFICATION IN A PRIVATE INSURER POPULATION Jamal Nabhani and David Ginsberg Jamal NabhaniJamal Nabhani More articles by this author and David GinsbergDavid Ginsberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.249AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The FDA public health notification (PHN) on transvaginal surgical mesh in October 2008 and subsequent update in July 2011 has prompted concerns from patient and provider alike about the use of graft material for the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). There has been limited investigation into the effect of these warnings on the surgical treatment of POP and SUI in the ensuing time. METHODS Claims from the Humana administrative database (5.2 million patients, 52% female with average age of 48 years, 307 million observed procedures) were queried using current procedural terminology (CPT) and international classification of disease, 9th Revision (ICD-9) codes for POP and/or SUI between January 2007 and November 2012, a time period spanning before, between, and after the PHN and update. RESULTS The query identified 69,786 distinct procedures for SUI and/or POP over the nearly 6 year period, of which 29,946 (42.9%) involved implantation or removal of mesh and 39,840 (57.1%) which did not. In 2008, 46.3% of procedures for POP or SUI involved mesh whereas the use of mesh declined to 35.2% in 2012 (p < 1.8x10-7). The main driver of this change was the decreased rate of POP repair with mesh from 24.1 (cases/month per 100,000 female beneficiaries) in 2008 to 18.9 in 2012 (p=0.001). Over the same period, mesh removal/revision rates increased (2.4 to 5.7, p=4.2x10-5). The rate of sling procedures between 2008 and 2012 did not significantly change (58.2 to 58.9, p=0.46). CONCLUSIONS The FDA PMH has significantly decreased the use of surgical mesh in POP surgery although the overall incidence of surgical treatment for POP and SUI has increased. POP repair with mesh has significantly decreased while mesh removal/revision makes up a larger portion of mesh procedures performed. The rate of sling procedures for SUI has been unchanged over the same period. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e62 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jamal Nabhani More articles by this author David Ginsberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...