Surgeon Experience and Complications of Transvaginal Prolapse Mesh
Surgeon Experience and Complications of Transvaginal Prolapse Mesh
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DOI：
10.1097/aog.0000000000001450
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发表时间：
2016-07-01
影响因子：
7.2
通讯作者：
Welk, Blayne
中科院分区：
文献类型：
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作者：
Kelly, Erin C.;Winick-Ng, Jennifer;Welk, Blayne
目的：测量女性经阴道脱垂补片并发症的比例及其与外科医生手术量的相关性。方法：我们对2002年至2013年期间在加拿大安大略接受基于补片的脱垂手术的所有女性进行了一项回顾性、基于人群的队列研究，使用管理数据（医院手术和医生账单记录）。主要结局为补片的手术翻修。主要暴露是外科医生体积：每年确定高（大于第75百分位数，每年需要中位数5次[四分位数范围5-6]手术）和非常高（大于第90百分位数，每年需要中位数13次[四分位数范围11-14]手术）的补片体积。主要分析采用调整后的考克斯比例风险模型。结果：共有5,488名女性接受了由368名外科医生中的1名进行的补片植入术。中位随访时间为5.4年（四分位距3.0-8.0）。我们发现，218名女性（4.0%）在植入后中位数1.17年（四分位距0.58-2.90）接受补片再次手术。仅在手术量非常大的患者中，因并发症而再次手术的风险较低（3.0% [145/3，001]与4.8% [73/2，447]，调整后的风险比为0.59，95%置信区间为0.40-0.86）。在多变量建模，年轻的年龄，伴随子宫切除术，输血，并增加医疗并发症都与阴道mesh reoperation.CONCLUSION：大约5%的妇女接受了基于网状脱垂手术需要再手术的网状并发症在10年内。每年进行14次或更多手术的外科医生再次手术的风险最低。
OBJECTIVE: To measure the proportion of women with transvaginal prolapse mesh complications and their association with surgeon volume.METHODS: We conducted a retrospective, population-based cohort study of all women who underwent a mesh-based prolapse procedure using administrative data (hospital procedure and physician billing records) between 2002 and 2013 in Ontario, Canada. The primary outcome was surgical revision of the mesh. Primary exposure was surgeon volume: high (greater than the 75th percentile, requiring a median of five [interquartile range 5-6] procedures per year) and very high (greater than the 90th percentile, requiring a median of 13 [interquartile range 11-14] procedures per year) volume mesh implanters were identified each year. Primary analysis was an adjusted Cox proportional hazards model.RESULTS: A total of 5,488 women underwent mesh implantation by 1 of 368 unique surgeons. Median follow-up time was 5.4 (interquartile range 3.0-8.0) years. We found that 218 women (4.0%) underwent mesh reoperation a median of 1.17 (interquartile range 0.58-2.90) years after implantation. The hazard of reoperation for complications was only lower for patients of very high-volume surgeons (3.0% [145/3,001] compared with 4.8% [73/2,447], adjusted hazards ratio 0.59, 95% confidence interval 0.40-0.86). In multivariable modeling, younger age, concomitant hysterectomy, blood transfusion, and increased medical comorbidity were all associated with vaginal mesh reoperation.CONCLUSION: Approximately 5% of women who underwent mesh-based prolapse surgery required reoperation for a mesh complication within 10 years. The risk of reoperation was lowest for surgeons performing 14 or more procedures per year.