Complication Rates Low for Incontinence Sling Procedures

Kate Johnson

March 15, 2016

MUNICH — When it comes to which surgical specialty is best suited to perform sling procedures, women with stress urinary incontinence can confidently go to either a gynecologist or a urologist, new research suggests.

Despite the number of litigations related to sling procedures, the overall complication rate is very low, said lead investigator Björn Löppenberg, MD, from the Department of Urologic Surgery and the Center for Surgery and Public Health at Brigham and Women's Hospital in Boston.

"However, we were able to identify certain patients who are at risk for complications" who should be observed more intensely, regardless of which surgical specialty is treating them, he reported here at the European Association of Urology 2016 Congress.

Dr Löppenberg and his colleagues assessed 10,508 sling procedures in the American College of Surgeons National Surgical Quality Improvement Program database that were performed to treat female stress urinary incontinence from 2005 to 2013.

Urologists performed 43.2% of the procedures and gynecologists performed 56.8%.

Comparing Urologists and Gynecologists

Urology patients were significantly older than gynecology patients (P < .05), had higher comorbidity rates (P < .05), and had more American Society of Anesthesiologists (ASA) scores of at least 3 (P < .05). Gynecologists performed significantly more additional procedures than urologists (22.2% vs 10.5%, < .0001).

Patients at risk for complications were older, more obese, had an ASA score of at least 3 (odds ratio [OR], 1.6; = .001), and had a prolonged operative time (OR, 1.9; < .0001). "These factors have to be taken into account when counseling patients for a sling procedure," said Dr Löppenberg.

There were no differences in cardiovascular, pulmonary, thrombotic, septic, renal, wound, or bleeding complications 30 days after surgery between the two specialties.

However, there were significantly more urinary tract infections, which made up 84.3% of all 30-day complications, in gynecology patients than in urology patients (3.6% vs 2.3%; OR, 1.55; < .0001).

Complication Rate of 3.5%

The overall complication rate 30 days after the procedure was 3.5%. That rate was slightly higher in gynecology patients than in urology patients (4.1% vs 2.9%; OR, 1.42; =.001).

The reason for this is unclear. "It may be a difference in specialty training; however, this database only gives general specialty, so we were not able to assess subspecialty," Dr Löppenberg explained. "In any case, the difference is very small."

It is not surprising that urologists had lower complication rates, despite having older patients with more comorbidities, said Joceline Liu, MD, from the Department of Urology at Northwestern University in Evanston, Illinois.

"This clinically makes sense, as urologists are often treating potentially more complex cases of stress urinary incontinence that are associated with other urologic conditions, while gynecologists may more commonly treat uncomplicated cases in patients without prior urethral surgeries," she told Medscape Medical News.

"That being said, the definition of 'complication' in most cases was urinary tract infection, which, while interesting, may be less clinically significant. It is difficult to properly match these two patient populations, as there is inherent bias in referral patterns and differences in comorbid conditions between specialties," Dr Liu said.

"It would be interesting to further analyze the data for outcomes and complication rates for sling among subspecialty-trained physicians," such as urogynecologists and female pelvic medicine and reconstructive surgeons, she added.

Dr Löppenberg and Dr Liu have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2016 Congress: Abstract 7. Presented March 12, 2016.

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