Effectiveness of Mesh Compared With Nonmesh Sling Surgery in Medicare Beneficiaries

Abstract

Objective: To assess the effectiveness of mesh compared with nonmesh slings placed in different surgical settings, as measured by the frequency of complications within 1 year. Methods: We performed a retrospective cohort study of Medicare beneficiaries undergoing sling surgery from 2006 to 2008 in hospital outpatient departments and hospital-based ambulatory surgery centers. Slings were identified and categorized according to the use of mesh by Healthcare Common Procedure Coding System codes and temporary “C” Healthcare Common Procedure Coding System codes. Patients were followed for 1 year after each procedure to identify complications. Logistic models were fit to assess relationships between sling type, surgical setting and various complications. Results: We identified 6,698 Medicare beneficiaries who underwent mesh sling procedures and 445 Medicare beneficiaries who underwent nonmesh sling procedures. The overall frequency of complications was similar between the two groups, at 69.8% and 72.6% in the mesh and nonmesh groups (p=0.22). Infectious complications were the most common complication at 45.4% and 50.1% of the mesh and nonmesh groups (p=0.06). Patients undergoing mesh procedures were less likely than patients undergoing nonmesh procedures to require management for bladder outlet obstruction (13.9% compared with 19.3%; adjusted odds ratio [OR] 0.66, 95% confidence interval [CI] 0.52–0.85), and were less likely to have a subsequent sling removal and revision or urethrolysis (2.7% compared with 4.7%; adjusted OR 0.56, 95% CI 0.35–0.89). Conclusion: Frequencies of most complications were similar regardless of the use of mesh except for the management of bladder outlet obstruction. These results did not differ based on the surgical setting where the sling procedure was performed.

The effects of menopause on the quality of life and longterm outcomes of transobturator tape treatment in women with stres urinary incontinence

“…Urinary tract infection, another complication encountered after mid-urethral sling operations, occurs at a rate of 34% in the first three months and 50% in the first year ( 21 , 22 ). The prevalence of recurrent UTI is reported as 6.4% in various case series ( 23 ).…”

Complicaciones intraoperatorias y posoperatorias de las cintas medio uretrales libres de tensión en incontinencia urinaria de esfuerzo

“…(15) Se informa que las tasas de ivu después de la colocación de cabestrillo medio uretral son tan altas como 34% dentro de los primeros 3 meses de cirugía, y hasta 50% después de 1 año. (16,17) Por el contrario, un estudio israelí observó una tasa del 21% en el primer año del período postoperatorio. (18) La ivu recurrente postoperatoria se informó en otro estudio entre el 6,4% de los pacientes.…”

Risk factors for urinary tract infection after midurethral sling placement

“…(4) La cinta medio uretral (CMU) es el tratamiento de le elección para las pacientes con incontinencia urinaria de esfuerzo, (5) se considera una cirugía de mínima invasión con tasas de éxito elevadas, sin embargo, no están exentas de complicaciones. (6) Se informa que las tasas de IVU después de la colocación de CMU en general van del 6% al 50% después de 1 año, (7)(8)(9) siendo más frecuente posterior a la colocación de CMU retropúbica (TVT) respecto a la CMU transobturadora (TOT). (10) La IVU recurrente postoperatoria se reporta con una frecuencia que va de 2.6% al 6,4% .…”