title: Short-term outcomes of vaginal mesh placement among female Medicare beneficiaries.
abstract: OBJECTIVE
  To compare short-term outcomes between prolapse repairs with and without mesh using a national data set. Mesh use in surgical treatment of pelvic organ prolapse has gained wide popularity. However, mesh complications have increased concomitantly with its use.
  
  
  METHODS
  Public Use File data were obtained for a 5% random national sample of female Medicare beneficiaries aged 65 years and older. Women who underwent prolapse surgery were identified using Current Procedural Terminology Coding System, Fourth Edition (CPT-4) codes. Because the code for mesh placement was effected in 2005, we separated patients into 3 cohorts as follows: those who underwent prolapse repairs from 1999 to 2000 (presumably without mesh), those who underwent repairs from 2007 to 2008 (presumably without mesh), and those with mesh (based on CPT-4 code 57267) from 2007 to 2008. One-year outcomes were identified using International Classification of Diseases, Ninth Revision diagnosis and procedure codes and CPT-4 procedure codes.
  
  
  RESULTS
  A total of 9180 prolapse repairs without mesh were performed from 1999 to 2000, 7729 without mesh from 2007 to 2008, and 1804 prolapse repairs with mesh from 2007 to 2008. Prolapse reoperation within 1 year of surgery was higher in nonmesh vs mesh cohorts (6%-7% vs 4%, P <.02). Mesh removal rates were higher in mesh vs nonmesh group (4% vs 0%-1%, P <.001). Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling.
  
  
  CONCLUSIONS
  Mesh to treat pelvic organ prolapse and stress urinary incontinence was associated with a small decrease in early reoperation for prolapse. This decrease came at the expense of increased rates of pelvic pain, retention, mesh-related complications, and mesh removal.
authors.affiliation: Division of Urology, Department of Surgery, Cedars-Sinai Medical Center. Electronic address: angerj@cshs.org.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
authors.affiliation: Department of Urology, University of California, Los Angeles.
authors.forename: Aqsa A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Division of Urology, Department of Surgery, Cedars-Sinai Medical Center.
authors.forename: Karyn S
authors.initials: KS
authors.lastname: Eilber
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Erin
authors.initials: E
authors.lastname: Chong
authors.affiliation: Department of Urology, University of California, Los Angeles.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Histed
authors.affiliation: United BioSource Corporation.
authors.forename: Ning
authors.initials: N
authors.lastname: Wu
authors.affiliation: United BioSource Corporation.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Pashos
authors.affiliation: Department of Urology, University of Michigan.
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006278:Medicare; D059952:Pelvic Floor Disorders / Q000628:therapy; D056887:Pelvic Organ Prolapse / Q000601:surgery; D012086:Reoperation; D053825:Suburethral Slings; D013526:Surgical Mesh; D016896:Treatment Outcome; D014481:United States; D014549:Urinary Incontinence / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery*