title: Perioperative complications and reoperations after incontinence and prolapse surgeries using prosthetic implants.
abstract: OBJECTIVE
  To estimate the perioperative complication and reoperation rates associated with slings and prolapse repairs using mesh and biologic grafts.
  
  
  METHODS
  Analysis of all female members of Kaiser Permanente Southern and Northern California and Hawaii who underwent sling procedures or pelvic organ prolapse surgeries using implanted grafts or mesh between September 1, 2008, and May 31, 2010. Physicians' Current Procedural Terminology Coding System, 4th edition, International Classification of Diseases, 9th Revision, and surgical implant logs were used to identify the procedures performed, implants used, perioperative complications, and readmissions and reoperations within 12 months of the index surgery.
  
  
  RESULTS
  During the 21-month period, 4,142 women (mean age 57 years [standard deviation 12.2], median parity 3 [interquartile range 1-4], median body mass index 28 [interquartile range 25-32]) underwent 3,747 (71%) slings and 1,508 (29%) prolapse repair procedures using implanted prostheses. Trocar-related bladder perforations (51 of 3,747 [1.4%]) occurred more commonly than urethral perforations (2 of 3,747 [0.05%]) in sling procedures (P<.001). There were no trocar-related injuries for prolapse repair kit procedures. Mesh-related reoperations after sling procedures were performed for voiding dysfunction or urinary retention (49 of 3,747 [1.3%]), vaginal mesh erosion (30 of 3,747 [0.8%]), and urethral erosion (3 of 3,747 [0.08%]). Reoperations after prolapse procedures were performed more often for vaginal mesh erosion (29 of 858 [3%]) than for biologic graft infection (2 of 650 [0.3%]; P=.01) and were performed more commonly after anterior (19 of 307 [6%]) compared with apical (9 of 487 [2%]) or posterior vaginal mesh repairs (1 of 64 [2%]; P=.018).
  
  
  CONCLUSIONS
  Reoperations for mesh-related complications occurred most often after transvaginal mesh placement in the anterior vagina.
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente, Downey, Roseville, CA 90242, USA. John.N.Nguyen@kp.org
authors.forename: John N
authors.initials: JN
authors.lastname: Nguyen
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Jakus-Waldman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Walter
authors.forename: Terry
authors.initials: T
authors.lastname: White
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Menefee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D053825:Suburethral Slings; D013526:Surgical Mesh; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries / Q000601:surgery; D014549:Urinary Incontinence / Q000601:surgery*; D014596:Uterine Prolapse / Q000601:surgery*; D055815:Young Adult