title: Safety of Mesh for Vaginal Cystocele Repair: Analysis of National Patient Characteristics and Complications.
abstract: The use of mesh in vaginal cystocele repair has decreased. We analyzed the ACS NSQIP® (American College of Surgeons National Surgical Quality Improvement Project) database to compare outcomes of repairs with and without mesh.
  
  
  
  CPT was used to identify patients who underwent cystocele repair with and without mesh from 2006 to 2013. Patient characteristics and complications were analyzed.
  
  
  
  We identified 6,849 patients, of whom 5,667 (82.5%) underwent native tissue repair and 1,182 (17.5%) underwent repair with mesh. Patients who received mesh were older (mean ± SD age 64 ± 11 vs 60 ± 12 years, p <0.001) and more had comorbidities (56% vs 47%, p <0.001). Mean mesh vs nonmesh operative time (97 ± 67 vs 95 ± 53 minutes, p = 0.2) and mean length of stay (1.3 ± 2.4 vs 1.4 ± 1.3 days, p = 0.2) were similar in the 2 groups. Urinary tract infection was the most common complication in cases without vs with mesh (3.8% vs 3.5%). Mesh procedure rates of mortality (0% vs 0.3%, p = 0.04) and overall surgical complications (1.8% vs 3.9% p <0.001) were higher. On multivariate analysis ASA® class 3 or greater (OR 1.4, p = 0.01), longer operative time (OR 1.004, p <0.001) and mesh (OR 1.32, p = 0.05) were associated with greater morbidity. Patient comorbidities, surgeon specialty and concomitant procedures did not confer an increased risk of complications.
  
  
  
  Native tissue repair is performed more commonly than mesh repair. ASA class, operative time and mesh use are associated with an increased risk of postoperative morbidity. These results suggest an increased risk of complications when using mesh in vaginal anterior repair, although the overall risk in each procedure was low.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Marissa C
authors.initials: MC
authors.lastname: Theofanides
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Ifeanyi
authors.initials: I
authors.lastname: Onyeji
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Justin
authors.initials: J
authors.lastname: Matulay
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Wilson
authors.initials: W
authors.lastname: Sui
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Maxwell
authors.initials: M
authors.lastname: James
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York. Electronic address: Dec2154@cumc.columbia.edu.
authors.forename: Doreen E
authors.initials: DE
authors.lastname: Chung
mesh_terms: D015897:Comorbidity; D052858:Cystocele / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D013526:Surgical Mesh / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: cystocele; postoperative complications; prolapse; surgical mesh; urinary bladder