title: Risk factors for vaginal mesh exposure after mesh-augmented anterior repair: a retrospective cohort study.
abstract: OBJECTIVE
  The aim of this study is to identify risk factors for vaginal mesh exposure after mesh-augmented repair of anterior prolapse.
  
  
  METHODS
  We performed a retrospective cohort study of all patients who had mesh-augmented anterior repair by 1 surgeon between January 2007 and February 2012. Data were extracted from medical records. The primary outcome was the rate of anterior or apical vaginal mesh exposure. Both univariate and multivariate analyses were performed.
  
  
  RESULTS
  A total of 201 subjects were included. The mean (SD) follow-up was 14.3 (12.4) months. All cases were done using a type 1 macroporous monofilament polypropylene mesh. The overall mesh exposure rate was 8.5% (17/201). Univariate analysis showed a statistically significant positive association between exposure rates and the following risk factors: lower body mass index (BMI) (P = 0.016), menopause in combination with the use of hormone replacement therapy (P = 0.023), midline sagittal vaginal incision (compared with distal transverse incision) (P = 0.026), concurrent total hysterectomy (P < 0.001), surgery time (P = 0.002), and worse apical prolapse at baseline (P = 0.007). After multivariate analysis using logistic regression, only BMI (P < 0.001) and concomitant total hysterectomy (odds ratio, 48; P < 0.001) remained relevant. The exposure rate was 23.5% (16/68) when concomitant hysterectomy was performed compared with 0.8% (1/133) when no hysterectomy was done. Exposure rates stratified by BMI class were 12.9% (8/62) for BMI less than 25 kg/m, 9.5% (8/84) for BMI of 25 to 29.9 kg/m, 3.1% (1/32) for BMI of 30 to 34.9 kg/m, and 0% (0/23) for BMI greater than or equal to 35 kg/m.
  
  
  CONCLUSIONS
  Concomitant total hysterectomy is an independent risk factor for mesh exposure after mesh-augmented anterior repair, whereas BMI may negatively correlate with exposure rates.
authors.affiliation: From the *Division of Urogynecology and Pelvic Reconstructive Surgery, WellSpan Health, York, PA; †Division of Female Pelvic Medicine and Reconstructive Surgery, University of California Davis, Sacramento, CA; ‡Division of Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, PA; and §Center of Urogynecology and Pelvic Reconstructive Surgery, Christiana Care Health System, Newark, DE.
authors.forename: Dominique
authors.initials: D
authors.lastname: El-Khawand
authors.forename: Salim A
authors.initials: SA
authors.lastname: Wehbe
authors.forename: Peter G
authors.initials: PG
authors.lastname: O'Hare
authors.forename: Divya
authors.initials: D
authors.lastname: Arunachalam
authors.forename: Babak
authors.initials: B
authors.lastname: Vakili
mesh_terms: D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011126:Polypropylenes / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention; D013526:Surgical Mesh / Q000009:adverse effects*; D014621:Vagina
chemical_list: D011126:Polypropylenes