title: Suburethral sling procedures in the United States: complications, readmission, and reoperation.
abstract: OBJECTIVE
  Hospital readmission is increasingly used as a measure of quality care. Our objective was to evaluate the rate of readmission and associated factors in women undergoing suburethral sling placement in the USA.
  
  
  METHODS
  This is a cohort study of suburethral sling procedures performed in the USA from 2012 to 2014 using the American College of Surgeons' National Surgical Quality Improvement Program database. The database was queried for suburethral sling procedures. Records were excluded if concomitant surgery had been performed. Patient and surgical characteristics were evaluated for association with readmission using Chi-squared test for categorical variables and Student's t test for continuous variables. All results yielding p < 0.05 were deemed statistically significant.
  
  
  RESULTS
  A total of 7,117 suburethral sling procedures were identified. There were 83 (1.16%) hospital readmissions. Those who were readmitted tended to be older (p = 0.011), non-Hispanic (p = 0.04), smokers (p < 0.001), and have an American Society of Anesthesiologists Physical Status Classification System score of 3 or 4 (p = 0.001). A history of bleeding disorder (p < 0.001), congestive heart failure (p < 0.001), or chronic obstructive pulmonary disease (p < 0.001) was associated with readmission. Fifty-four (0.75%) patients underwent reoperation within 30 days of suburethral sling placement. The most common reoperation procedure was sling excision (20 patients). The most common complication was urinary tract infection, which occurred in 189 patients (2.7%).
  
  
  CONCLUSIONS
  Suburethral sling placement is a safe procedure with a low rate of readmissions, reoperations, and complications. Consistent with other types of surgery, infection is the most common post-operative complication.
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, 85 Seymour Street, Suite 525, Hartford, CT, 06106, USA. katie.propst@hhchealth.org.
authors.forename: Katie
authors.initials: K
authors.lastname: Propst
authors.affiliation: Research Administration, Hartford Hospital, Hartford, CT, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: O'Sullivan
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, 85 Seymour Street, Suite 525, Hartford, CT, 06106, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Tulikangas
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data*; D053825:Suburethral Slings / Q000009:adverse effects / Q000706:statistics & numerical data*
keywords: Epidemiology; Patient readmission; Postoperative complications; Repeat surgery; Stress urinary incontinence; Surgical wound infection