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Predictors of sling revision after mid-urethral sling procedures: a case-control study.
BJOG. 2019 02; 126(3):419-426.BJOG

Abstract

OBJECTIVE

To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal.

DESIGN

Case-control study.

SETTING

Tertiary academic centre in Canada.

POPULATION

One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio).

METHODS

Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors.

RESULTS

The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here.

CONCLUSIONS

Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal.

TWEETABLE ABSTRACT

Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery.

Authors+Show Affiliations

Division of Urogynecology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.Division of Urogynecology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. The Ottawa Hospital Research Institute, Ottawa, ON, Canada.Division of Urogynecology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30220104

Citation

Clancy, A A., et al. "Predictors of Sling Revision After Mid-urethral Sling Procedures: a Case-control Study." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 126, no. 3, 2019, pp. 419-426.
Clancy AA, Gauthier I, Ramirez FD, et al. Predictors of sling revision after mid-urethral sling procedures: a case-control study. BJOG. 2019;126(3):419-426.
Clancy, A. A., Gauthier, I., Ramirez, F. D., Hickling, D., & Pascali, D. (2019). Predictors of sling revision after mid-urethral sling procedures: a case-control study. BJOG : an International Journal of Obstetrics and Gynaecology, 126(3), 419-426. https://doi.org/10.1111/1471-0528.15470
Clancy AA, et al. Predictors of Sling Revision After Mid-urethral Sling Procedures: a Case-control Study. BJOG. 2019;126(3):419-426. PubMed PMID: 30220104.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of sling revision after mid-urethral sling procedures: a case-control study. AU - Clancy,A A, AU - Gauthier,I, AU - Ramirez,F D, AU - Hickling,D, AU - Pascali,D, Y1 - 2018/10/24/ PY - 2018/08/29/accepted PY - 2018/9/17/pubmed PY - 2019/3/19/medline PY - 2018/9/17/entrez KW - Mesh complications KW - sling revision KW - suburethral sling KW - urinary incontinence SP - 419 EP - 426 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 126 IS - 3 N2 - OBJECTIVE: To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal. DESIGN: Case-control study. SETTING: Tertiary academic centre in Canada. POPULATION: One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio). METHODS: Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors. RESULTS: The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here. CONCLUSIONS: Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal. TWEETABLE ABSTRACT: Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/30220104/Predictors_of_sling_revision_after_mid_urethral_sling_procedures:_a_case_control_study_ L2 - https://doi.org/10.1111/1471-0528.15470 DB - PRIME DP - Unbound Medicine ER -