1544 Short-Term Outcomes of Vaginal Mesh Placement Among Female Medicare Beneficiaries

Abstract

Objectives-To compare short-term outcomes between prolapse repairs with and without mesh using a national dataset. Mesh use in surgical treatment of pelvic organ prolapse (POP) has gained wide popularity. However, mesh complications have increased concomitantly with its use. Methods-PublicUse File data were obtained for a 5% random national sample of female Medicare beneficiaries age 65 and over. Women who underwent prolapse surgery were identified by CPT-4 codes. Since the code for mesh placement was effected in 2005, we separated patients into three cohorts: those who underwent prolapse repairs from 1999-2000 (presumably without mesh), those who underwent repairs in 2007-2008 (presumably without mesh), and those with mesh (based on CPT-4 code 57267) in [2007][2008]. One-year outcomes were identified using ICD-9 diagnosis and procedure codes and CPT-4 procedure codes. Results DisclosuresKaryn S. Eilber is a speaker for Astellas; an investigator and consultant for American Medical Systems; and an investigator for Boston Scientific. J. Quentin Clemens is a consultant for Medtronic, Afferent Pharmaceuticals, and Amphora Medical; a speaker for Endo Pharmaceuticals; involved in trial participation with Taris; and a meeting participant with Allergen. All other authors report no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. vs. 4%, p < 0.02). Mesh removal rates were higher in mesh vs. non-mesh group (4% vs. 0-1%, p < 0.001). Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling. NIH Public AccessConclusions-Mesh to treat POP and stress urinary incontinence (SUI) was associated with a small decrease in early re-operation for prolapse. This decrease came at the expense of increased rates of pelvic pain, retention, mesh-related complications, and mesh removal.