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The Role of the Surgeon on Outcomes of Vaginal Prolapse Surgery With Mesh

Eilber, Karyn S. MD*; Alperin, Marianna MD, MS; Khan, Aqsa MD; Wu, Ning PhD§; Pashos, Chris L. PhD; Clemens, J. Quentin MD, MSCI; Anger, Jennifer T. MD, MPH*

Female Pelvic Medicine & Reconstructive Surgery: September/October 2017 - Volume 23 - Issue 5 - p 293–296
doi: 10.1097/SPV.0000000000000395
Original Articles

Introduction Adverse outcomes after surgery for pelvic organ prolapse (POP) with mesh are often attributed to the mesh material with little attention paid to the influence of surgeon factors. We used a national data set to determine whether surgeon case volume and specialty influenced vaginal prolapse surgery outcomes with mesh.

Materials and Methods Public Use File data on a 5% random national sample of female Medicare beneficiaries were obtained from the Centers for Medicare and Medicaid Services. Women with a diagnosis of POP who underwent surgery with mesh between 2007 and 2008 were identified by relevant International Classification of Diseases, 9th Revision, Clinical Modification and Current Procedural Terminology, 4th Edition procedure codes. Outcomes were compared by surgeon case volume and specialty.

Results From 2007 to 2008, 1657 surgeries for POP were performed with mesh. Low-, intermediate-, and high-volume surgeons performed 881 (53%), 408 (25%), and 368 (22%) of the cases with mesh, respectively. The cumulative reoperation rates for low-, intermediate-, and high-volume providers were 6%, 2%, and 3%, respectively. The difference in reoperation rates between low and intermediate and low- and high-volume surgeons was statistically significant (P = 0.007 and 0.003, respectively). There was no significant difference in reoperation rates between gynecologists and urologists when vaginal mesh was implanted for POP surgery.

Conclusions Low-volume surgeons performed most of the vaginal prolapse repairs with mesh and had significantly higher reoperation rates. Surgeon experience must be a consideration when reporting mesh-related complications of POP surgery.

Surgeon experience influences outcomes of vaginal prolapse surgery with mesh.

From the *Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles; †Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Reproductive Medicine, University of California, San Diego, San Diego; ‡Department of Urology, University of California, Los Angeles, Los Angeles, CA; §United BioSource Corporation, Chevy Chase, MD; ∥Takeda Pharmaceuticals International Inc, Cambridge, MA; and ¶Department of Urology, University of Michigan, Ann Arbor, MI.

Reprints: Karyn S. Eilber, MD, Cedars-Sinai Health System, 99 North La Cienega Boulevard, Suite 307, Beverly Hills, CA 90211. E-mail: karyn.eilber@cshs.org.

Dr Eilber is a consultant for Allergan and an investigator for Astellas and Boston Scientific. Dr Anger is an investigator for Astellas and an expert witness for Boston Scientific. The remaining authors have declared they have no conflicts of interest.

Source of funding: Funded by the National Institute of Diabetes and Digestive and Kidney Diseases (1 K23 DK080227-05, JTA) and an American Recovery and Reinvestment Act (ARRA) Supplement.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.