Reoperations and Readmissions Following Isolated Midurethral Slings

Objectives: To describe the types of reoperations and reasons for readmissions following midurethral sling (MUS). Secondary objectives included describing the rates of any 30-day adverse events following MUS as well as patient characteristics associated with any 30-day adverse event.

Methods: Female patients undergoing isolated MUS were identified in the National Surgical Quality Improvement Program (NSQIP) Database between years of 2019 and 2022 using Current Procedural Terminology (CPT) Codes. NSQIP tracked codes for postoperative complications, reoperations and readmissions as well as non-tracked codes for reoperation and readmissions were collected. The primary outcome was any reoperation and readmission following MUS, describing specific surgical procedures performed at the time of reoperation using CPT codes and reasons for readmission using International Classification of Diseases 10 (ICD-10) codes. Secondary outcomes included any 30-day adverse event, defined as a composite outcome including any 30-day complication, readmission or reoperation. Descriptive statistics were used to characterize the overall cohort. Differences in patient characteristics across outcomes were described using chi-square and t-tests where appropriate. Univariable logistic regression analyses and multivariable logistic regression analyses were performed to identify factors associated with any 30-day postoperative adverse events.

Results: During the study period, 9771 patients met inclusion criteria. The rate of any reoperation was 1.0% (91/9771). Table 1 describes the outcomes of interest. In regards to tracked CPT codes (n=47), the most common reoperations were sling revision (n=32), cystourethroscopy (n=8), replacement of sling (n=5), and urethrolysis secondary, open (n=2). Most common non-tracked reoperations (n=39) were other gastrointestinal procedures (n=9, e.g., excision procedures on the intestine; removal of fecal impaction or foreign body; and exploratory laparotomy) and other gynecologic procedures (n=7, e.g., laparoscopic sling operation for SUI). The rate of any readmission was 0.9% (86/9771). The most common tracked reason for readmission (n=23) was urinary tract infection (n=7) followed by pneumonia (n=4), sepsis (n=4) and superficial surgical site infection (n=3). There were 64 readmissions with non-tracked codes, the most common of which was unspecified retention of urine (n=14), SUI (n=10), other postprocedural complications and disorders of the Genitourinary system (n=7). The rate of any adverse event was 7.7% with postoperative complications at 6.6%. In a multivariable logistic regression model controlling for age, body mass index, history smoking, hypertension, diabetes, and operative time and ASA class, ASA class level III was the only factor associated with increased odds of any adverse events following MUS.

Conclusions: This study describes in detail the types of reoperations and readmissions patients experience following isolated MUS. While the most common reoperation was sling revision, GI related procedures made up 10% of the reoperations in the 30-days following surgery. While UTI was the leading reason for readmission, 16% of readmissions were due to urinary retention.