title: Population based trends in procedures following sling surgery for urinary incontinence.
abstract: OBJECTIVE
  To investigate practice patterns and variation associated with sling removal/revision and urethrolysis on a population level.
  
  
  METHODS
  We used CPT 4 codes and the State Ambulatory Surgery Database (SASD) to identify all ambulatory procedures for sling removal/revision and urethrolysis from 2004 to 2009 in Florida. Next, we calculated adjusted rates for these procedures and measured regional variation in rates at the level of the Hospital Service Area (HSA).
  
  
  RESULTS
  During this time period, rates of secondary procedures following slings more than doubled from 3.2 per 100,000 to 6.5 per 100,000 population (p<0.001). There was a large amount of regional variation, with rates of these procedures varying more than 5-fold across HSAs. Regions that placed more slings did not necessarily have higher rates of secondary procedures following sling placement.
  
  
  CONCLUSIONS
  The large amount of variability in rates of secondary procedures following slings signifies considerable uncertainty about the indications for these procedures. Further research is warranted to better explain potential sources for this variation in order to improve the quality of care surrounding midurethral sling placement and the recognition and treatment of its complications.
authors.affiliation: Dow Division of Health Services Research, Department of Urology, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA. suskina@med.umich.edu
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: John T
authors.initials: JT
authors.lastname: Stoffel
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005431:Florida; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012086:Reoperation / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000601:surgery*; D055815:Young Adult