Long-term Risk of Reoperation After Synthetic Mesh Midurethral Sling Surgery for Stress Urinary Incontinence

OBJECTIVE:To measure the long-term reoperation risk after synthetic mesh midurethral sling surgery. METHODS:This retrospective cohort study evaluated all patients who underwent a midurethral sling surgery for stress urinary incontinence (SUI) (2005–2016) within a large managed care organization of 4.5 million members. We queried the system-wide medical record for Current Procedural Terminology and International Classification of Diseases, 9 or 10 Revision codes for patient data, and implant registry coding to assess the sling type. The primary outcome was the overall reoperation rate after midurethral sling, with secondary outcomes being reoperation for mesh revision, or removal and recurrent SUI. We used cumulative incidence to calculate reoperation risk as a function of time at least 1 year, least 5 years, and at least 9 years. We compared demographics, characteristics, and reoperation of patients using χ and Wilcoxon rank sum, and we used a Cox proportional hazards model to calculate adjusted hazard ratios. RESULTS:In this cohort of 17,030 patients treated with primary midurethral slings, the overall reoperation rate was 2.1% (95% CI 1.9–2.4%) at 1 year, 4.5% (95% CI 4.1–4.8%) at 5 years, and 6.0% (95% CI 5.5–6.5%) at 9 years. Risk of reoperation was affected by race (P=.04), with Asian or Pacific Islander patients having a lower reoperation rate when compared with white patients. Reoperation rate for mesh revision or removal was 0.7% (95% CI 0.6–0.8%) at 1 year, 1.0% (95% CI 0.8–1.1%) at 5 years, and 1.1% (95% CI 0.9–1.3%) at 9 years. Reoperation for recurrent SUI was 1.6% (95% CI 1.4–1.8%) at 1 year, 3.9% (95% CI 3.5–4.2%) at 5 years, and 5.2% (95% CI 4.7–5.7%) at 9 years. Risk of reoperation for recurrent SUI was affected by the type of sling, with reoperation more common after single-incision compared with retropubic sling (adjusted hazard ratio 1.5 [95% CI 1.06–2.11] P=.03). CONCLUSION:Midurethral slings have a low long-term risk of reoperation for mesh revision or removal, and recurrent SUI, adding to the evidence of their safety and efficacy for the treatment of women with SUI.