title: Use and risks of surgical mesh for pelvic organ prolapse surgery in women in New York state: population based cohort study.
abstract: OBJECTIVE
  To assess the use of mesh in pelvic organ prolapse surgery, and compare short term outcomes between procedures using and not using mesh.
  
  
  METHODS
  All inclusive, population based cohort study.
  
  
  METHODS
  Statewide surgical care captured in the New York Statewide Planning and Research Cooperative System.
  
  
  METHODS
  Women who underwent prolapse repair procedures in New York state from 2008 to 2011.
  
  
  METHODS
  90 day safety events and reinterventions within one year, after propensity score matching. Categorical, time to event, and subgroup analyses (<65 and ≥ 65 year age groups) were conducted.
  
  
  RESULTS
  Of 27,991 patients in total, 7338 and 20, 653 underwent prolapse repair procedures with and without mesh, respectively. Mesh use increased by 44.7%, from 1461 procedures in 2008 to 2114 procedures in 2011. Most patients in the cohort were younger than 65 years (62.3% (n=17,424/27, 991)). However, more patients were aged 65 years and older in the mesh group than in the non-mesh group (44.3% (n=3249) v 35.4% (n=7318)). Complications after surgery were not common, irrespective of the use or non-use of mesh. After propensity score matching, patients who received the surgery with mesh had a higher chance of having a reintervention within one year (mesh 3.3% v no mesh 2.2%, hazard ratio 1.47 (95% confidence interval 1.21 to 1.79)) and were more likely to have urinary retention within 90 days (mesh 7.5% v no mesh 5.6%, risk ratio 1.33 (95% confidence interval 1.18 to 1.51)), compared with those who received surgery without mesh. In subgroup analyses based on age, mesh use was associated with an increased risk of reintervention within one year in patients under age 65 years, and increased risk of urinary retention in patients aged 65 years and over.
  
  
  CONCLUSIONS
  Despite multiple warnings released by the US Food and Drug Administration since 2008, use of mesh in pelvic organ prolapse surgery continues to grow. In this statewide comprehensive study, mesh procedures were associated with an increased risk of reinterventions within one year and urinary retention after surgery.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.affiliation: Patient-Centered Comparative Effectiveness Program and MDEpiNet Science and Infrastructure Centre, Department of Healthcare Policy and Research at Weill Cornell Medical College and New York Presbyterian, New York, NY 10065, USA.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Buck
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Kaplan
authors.affiliation: Patient-Centered Comparative Effectiveness Program and MDEpiNet Science and Infrastructure Centre, Department of Healthcare Policy and Research at Weill Cornell Medical College and New York Presbyterian, New York, NY 10065, USA ars2013@med.cornell.edu.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009518:New York; D061214:Patient Safety; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome