title: Effect of anesthesia type on perioperative outcomes with a midurethral sling.
abstract: OBJECTIVE
  There is no consensus on the most appropriate type of anesthesia for placement of a midurethral sling. Our objective was to compare intra- and perioperative outcomes for this procedure performed under general anesthesia versus monitored anesthesia care.
  
  
  METHODS
  Retrospective cohort analysis of women undergoing outpatient placement of synthetic retropubic midurethral sling under general anesthesia (n = 141) or monitored anesthesia care (n = 84). Patients undergoing concomitant procedures were excluded. Primary outcome was operating room time. Secondary outcomes included surgical and recovery times, cost, discharge home with a catheter, and postoperative pain and/or nausea.
  
  
  RESULTS
  In the general anesthesia group, both operating room time (mean ± SD, 67.6 ± 13.3 min vs 56.9 ± 11.8 min, p < 0.001) and recovery room time (240.0 ± 69.8 min vs 190.1 ± 78.3 min, p < 0.001) were longer, whereas there was no difference in surgical time (30.0 ± 8.9 min vs 29.0 ± 9.7 min, p = 0.43). Cost was significantly higher in the general anesthesia group ($4,095 ± 715 vs $3,877 ± 777, p = 0.03). There was no difference in rates of bladder perforation (6.4 % vs 11.9 %, p = 0.33). Patients who underwent general anesthesia had higher rates of discharge with a catheter (27.0 % vs 15.8 %, p = 0.04).
  
  
  CONCLUSIONS
  Monitored anesthesia care may offer significant benefits over general anesthesia in women undergoing retropubic midurethral sling, including shorter operating room and recovery times, lower costs, and less voiding dysfunction in the immediate postoperative period.
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior, Suite 05-2370, Chicago, IL, 60611, USA. bhumydave@gmail.com.
authors.forename: Bhumy A
authors.initials: BA
authors.lastname: Davé
authors.affiliation: Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA.
authors.forename: Camaleigh
authors.initials: C
authors.lastname: Jaber
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior, Suite 05-2370, Chicago, IL, 60611, USA.
authors.forename: Alix
authors.initials: A
authors.lastname: Leader-Cramer
authors.affiliation: Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Higgins
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior, Suite 05-2370, Chicago, IL, 60611, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior, Suite 05-2370, Chicago, IL, 60611, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Lewicky-Gaupp
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior, Suite 05-2370, Chicago, IL, 60611, USA.|Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Anesthesia; Economics; Operative time; Suburethral sling; Urinary retention
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