National Surgical Trends and Perioperative Outcomes of Midurethral Sling Placement for Stress Urinary Incontinence.
OBJECTIVE
To determine contemporary trends, patient characteristics, and outcomes for midurethral sling placement (MUS) at inpatient and ambulatory facilities from a national database.


METHODS
Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 7767 women who underwent isolated MUS 2006-2012. We stratified patients by hospitalization type (outpatient vs hospitalization). Primary outcomes were 30-day complications, readmissions, and reoperations. Multivariable logistic regression was used to determine patient and surgery factors associated with adverse perioperative outcomes.


RESULTS
Among the 7767 women undergoing MUS, 84.3% underwent outpatient surgery (n = 6547), with greater use of outpatient facilities over time (P < .001). Overall, 3.9% of patients (n = 300) experienced one or more postoperative complications. Complications were more likely among inpatients (7.4% vs 3.2%; odds ratio [OR] 0.48, confidence interval [CI] 0.36-0.64, P < .001), with gynecologists as compared to urologists (4.4% vs 3.1%; OR 1.53, CI 1.16-2.02, P = .003), and with resident participation (5.1% vs 3.7%; OR 1.32, CI 1.01-1.73, P = .04). On multivariable analysis, outpatients were less likely to experience readmissions (0.9% vs 2.8%; OR 0.2, CI 0.09-0.56, P = .002) or undergo reoperation (0.3% vs 3.1%; OR 0.10, CI 0.02-0.38, P = .001).


CONCLUSIONS
Use of outpatient surgical centers for MUS is increasing, with lower rates of complications, readmissions, and reoperations compared to inpatient treatment. Although there is a difference in complications by specialty and with resident involvement, overall incidence of complications is low.
Division of Urology, MetroHealth Medical Center, Cleveland, OH.
Emily A
EA
Slopnick
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
Adonis K
AK
Hijaz
Division of Urology, MetroHealth Medical Center, Cleveland, OH.
Carvell T
CT
Nguyen
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
Robert
R
Abouassaly
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
Christopher M
CM
Gonzalez
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, University Hospitals Cleveland Medical Center, Cleveland, OH.
Sangeeta T
ST
Mahajan
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, University Hospitals Cleveland Medical Center, Cleveland, OH.
J Welles
JW
Henderson
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
Matthew J
MJ
Bream
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH. Electronic address: Simon.kim@uhhospitals.org.
Simon P
SP
Kim
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D055815:Young Adult