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The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair

Javadian, Pouya MD*; Shobeiri, S. Abbas MD, MBA, FACS, FACOG

Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 - Volume 24 - Issue 5 - p 375–379
doi: 10.1097/SPV.0000000000000489
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Objectives The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision.

Methods Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0–10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States

Results Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0–10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P < 0.0001).

Conclusions Vaginal mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were associated with increased economic burden on the families of the effected individuals and a drop in the family income in more than one third of the families.

From the *Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK; and

Department of Obstetrics and Gynecology, Virginia Commonwealth University, Inova Fairfax Hospital Women's Hospital, Falls Church, VA.

Correspondence: S. Abbas Shobeiri, MD, MBA, FACS, FACOG, Virginia Commonwealth University School of Medicine, Inova Women's Hospital, 3300 Gallows Rd, Suite W6306, Falls Church, VA 22042. E-mail: Abbas.Shobeiri@Inova.org.

S.A.S. has served as a consultant to AMS, Life Cell, and Motley Rice. P.J. has no conflicts of interest to declare.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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