Stress, Urinary Incontinence
Conditions
Keywords
surgical mesh, observational study, intraoperative complications, postoperative complications
Brief summary
Complications from mesh procedures (i.e. insertion of tension-free vaginal tapes (TVT), trans-obturator tapes (TOT) and suprapubic slings (SS)) used during surgical treatment of stress urinary incontinence have caused major concern around the world. The investigators aim to conduct a retrospective cohort study using administrative inpatient data from the Hospital Episode Statistics (HES) database to determine the complications of all first-time surgical mesh procedures in the treatment of stress urinary incontinence (SUI) in women treated in a National Health Service (NHS) hospital in England who were discharged from hospital between 1st April 2007 and 31st March 2015. The primary outcome measure is the number and types of complications (occurring peri-procedurally, within 30 days of the mesh procedure and those occurring during follow-up). Additional outcomes recorded include: the numbers and types of mesh procedures, including those with potentially confounding concomitant procedures.
Interventions
PROCEDURETension-free vaginal tape (TVT)
Surgical insertion of Tension-free vaginal tape (TVT) polypropylene mesh in the treatment of stress urinary incontinence.
PROCEDURETrans-obturator tape (TOT)
Surgical insertion of Trans-obturator tape (TOT) polypropylene mesh in the treatment of stress urinary incontinence.
PROCEDURESuprapubic sling (SS)
Surgical insertion of Suprapubic sling (SS) polypropylene mesh in the treatment of stress urinary incontinence.
Sponsors
Newcastle-upon-Tyne Hospitals NHS Trust
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Women with an Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures 4th revision (OPCS-4) procedure code for an introduction of a Tension-free Vaginal Tape (TVT: M53.3), Trans-Obturator Tape (TOT: M53.6) or Supra-pubic Sling (SS: M52.1) surgical mesh procedure recorded in any of the 24 procedure fields captured in HES, and a recorded diagnosis of stress urinary incontinence based on International Classification of Diseases 10th revision (ICD-10) diagnoses: N39.3, N39.4, R32: T83.1, T83.4, T83.5, T83.6, T83.6, T83.8, T83.9, Z46.6, in any of the 20 diagnosis fields captured in HES.
Exclusion criteria
* Duplicate episode of care (exact match on patient identifier; admission date and method; discharge date, destination and method; hospital, gender, age, all procedure codes and all diagnostic codes) * Male gender * Missing age * Aged less than 18 years * Invalid or missing admission method * Missing admission date * Patients with recorded episodes of care in HES which appear after a reported date of death. * Concomitant mesh surgery for pelvic organ prolapse surgery, or surgical mesh repair, removal, renewal or subsequent mesh insertion.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Long-term complications | Longitudinal analysis of all episodes of care available in HES (up to 96 months) | Readmission for further mesh surgery or for symptoms indicating complication |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nature of treatment-related adverse events as determined by clinical coding practice of ICD-10 codes (Aylin et al. BMJ. 2004) | During hospital admission when surgical mesh was inserted (length of hospital stay can vary between patients from 0-100 days) | Nature of complication |
| Frequency of 30-day complications | Occurring within 30 days of surgical mesh insertion procedure | Frequency and nature of complication |
| Nature of treatment-related adverse events occurring within 30 days of mesh procedure as determined by clinical coding practice of ICD-10 codes (Aylin et al. BMJ. 2004) | Occurring within 30 days of surgical mesh insertion procedure | Nature of complication |
| Type of mesh used | Longitudinal analysis of all episodes of care available in HES (up to 96 months) | Frequency of each type of mesh procedure (TVT, TOT, SS) used over time |
| Frequency of treatment-related adverse events during initial hospital stay for mesh insertion procedure | During hospital admission when surgical mesh was inserted (length of hospital stay can vary between patients from 0-100 days) | Frequency of complication |
Outcome results
None listed