ABSTRACT: The use of polypropylene mesh in midurethral slings for incontinence surgery has been well studied, and the procedure is commonly used. However, there are 2 serious concerns with respect to use of mesh in slings. The first is a common conception that the procedure may be associated with higher rates of complications when performed with mesh than without mesh. The second concern is that mesh procedures performed in nonhospital settings (ie, ambulatory surgery centers) may be less effective and negatively affect the quality of care.
This retrospective cohort study examined data from Medicare beneficiaries on the frequency of complications to compare the short-term effectiveness and safety of mesh and nonmesh slings placed in different surgical settings. The investigators used the appropriate Healthcare Common Procedure Coding System codes during a 2-year period to identify and categorize the type of material (mesh vs nonmesh), the type of surgery (open vs laparoscopic), and the setting (hospital outpatient departments vs hospital-based ambulatory surgery centers). Women aged 66 to 99 years who underwent a sling procedure were followed up for 1 year to identify complications. Logistic regression models were used to determine relationships among type of sling, surgical setting, and complications.
The final study population was composed of 6698 Medicare patients who had mesh slings placed and 445 patients who had nonmesh slings placed. The overall frequency of complications was similar between mesh and nonmesh groups: 69.8% and 72.6%, respectively (P = 0.22). The most common complications were infectious complications, which occurred in 45.4% and 50.1% of the mesh and nonmesh groups, respectively (P = 0.06). Logistic regression analysis showed that women treated with mesh were less likely to require a secondary procedure for bladder outlet obstruction (13.9% vs 19.3% [adjusted odds ratio, 0.66; 95% confidence interval, 0.52–0.85]; P < 0.01) and were less likely to have a subsequent sling removal and revision or urethrolysis (2.7% vs 4.7% [adjusted odds ratio, 0.56; 95% confidence interval, 0.35–0.89]; P = 0.03).
Patients treated with mesh and without mesh had comparable rates of complications except for the management of bladder outlet obstruction. The data show higher rates of obstruction and its subsequent management among nonmesh patients. The likelihood of complications did not vary with respect to the surgical setting where the procedure was performed.
Dow Division of Health Services Research and the Division of Neurology and Pelvic Reconstructive Surgery, Department of Urology, The University of Michigan, Ann Arbor, MI