Abstract

INTRODUCTION: Several factors are hypothesized to impact the risks of mesh-augmented pelvic organ prolapse (POP) repair including, 1) characteristics of the material itself, 2) surgical experience, and 3) patient selection. We present a large population-based approach to explore their impact on outcomes and to describe an ideal mesh usage strategy.METHODS: Data from the Office of Statewide Health Planning and Development was accessed identifying all women undergoing POP repair in California from 2005-2011. Multivariate mixed effects logistic regression models were constructed to explore which patient, surgical and facility factors were associated with repeat surgery for a complication due to mesh or POP recurrence.RESULTS: A total of 110,329 women underwent POP repairs during the study period of which 16.2% utilized mesh. The overall repeat surgery rate was higher in women undergoing mesh repairs (5.4% vs 4.3%, p<0.001). However, multivariate modeling revealed that mesh itself was not independently associated with repeat surgery; rather repair at a facility with a greater propensity to utilize mesh was (OR=1.55 in the highest quartile proportion of mesh use, as compared to the lowest, p<0.01). Further modeling revealed the lowest risk occurred when mesh is utilized in 5% of anterior and 10% of anterior-apical repairs.CONCLUSION: Our findings demonstrate mesh is not independently associated with an increase in complication rates for POP repair on a large scale. We present a model that supports judicious use of the product on a population level that balances the risk of complications against that of POP recurrence.

View details for PubMedID 29510170