Comparison of Perioperative Outcomes of Autologous Bladder Neck Fascial Slings Based on Fascial Harvest Site: A Secondary Analysis of the National Surgical Quality Improvement Program Database

Abstract

Objectives The objective of this study was to compare perioperative outcomes of autologous bladder neck fascial slings (ABNFS) between rectus fascia and fascia lata harvest sites. Methods We analyzed women undergoing ABNFS in the 2006 to 2015 American College of Surgeons National Surgical Quality Improvement Program database, separating rectus fascia and fascia lata harvest sites by Current Procedural Terminology codes. We compared the 2 harvest sites for perioperative outcomes within 30 days including adverse events, readmission, and reoperation as well as operative time and length of hospital stay. The primary outcome was a composite of postoperative adverse events, readmission, and reoperation. A multivariable logistic regression model was used incorporating race, smoking status, surgical specialty, anesthesia class, concurrent procedures, body mass index, operating time, and length of hospital stay. Results A total of 161 women in the database underwent ABNFS: 126 (78.3%) rectus fascia and 35 (21.7%) fascia lata harvest. Patients undergoing rectus fascial harvest were more likely to be white (140 [90.5%] rectus vs 26 [74.3%] fascia lata, P=0.02) and more likely to have ABNFS by a urologist (117 [93%] rectus vs 23 [66%] fascia lata, P < 0.01). There were no significant differences in operative time, length of stay, rate of reoperation, nonserious or serious adverse events, or readmission between the 2 harvest site groups. The 2 harvest sites had similar composite morbidity (adjusted odds ratio of 0.88 for rectus fascia; 95% confidence interval, 0.21–3.75; P=0.87). Conclusions Rectus fascia and fascia lata harvest for ABNFS have similar perioperative outcomes.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry

“…However, when excluding UTIs, the rates of composite adverse events were comparable. Our observations regarding significant perioperative adverse events align with earlier research that examined outcomes after autologous sling surgery among different harvesting sites 9 . A previous study that utilized the ACS‐NSQIP database also noted no differences in mild or severe adverse events or readmission frequencies between rectus fascia and fascia lata harvest sites.…”

“…However, this study included patients undergoing concurrent procedures unrelated to the sling, which complicates the assessment of whether the adverse events were directly related to the sling procedure or the concurrent procedure. 9 Our study accounts for concomitant procedures and strengthens these prior findings. Likewise, a separate study conducted at a single institution compared perioperative and functional outcomes for autologous fascia lata and rectus fascia slings, revealing similar adverse event rates for both fascial harvest sites.…”

“…A previous study that utilized the ACS‐NSQIP database also noted no differences in mild or severe adverse events or readmission frequencies between rectus fascia and fascia lata harvest sites. However, this study included patients undergoing concurrent procedures unrelated to the sling, which complicates the assessment of whether the adverse events were directly related to the sling procedure or the concurrent procedure 9 . Our study accounts for concomitant procedures and strengthens these prior findings.…”

“…One study utilized a large national surgical database to compare outcomes between autologous sling placement using rectus fascia and fascia lata. 9 However, a considerable proportion of the surgeries involved concomitant procedures, potentially introducing confounding factors into the findings. There is currently a lack of literature on short-term adverse events after suburethral sling placement using synthetic mesh compared to autologous fascia and among different fascial harvest sites in a multiinstitutional and generalizable cohort.…”

“…While prior studies have described and compared outcomes between different sling materials and harvest sites, these studies were predominantly from a single institution with a small sample size. One study utilized a large national surgical database to compare outcomes between autologous sling placement using rectus fascia and fascia lata 9 . However, a considerable proportion of the surgeries involved concomitant procedures, potentially introducing confounding factors into the findings.…”