Slopnick Emily A, Hijaz Adonis K, Nguyen Carvell T, Abouassaly Robert, Gonzalez Christopher M, Mahajan Sangeeta T, Henderson J Welles, Bream Matthew J, Kim Simon P
Division of Urology, MetroHealth Medical Center, Cleveland, OH.
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
Urology. 2017 Jan;99:57-61. doi: 10.1016/j.urology.2016.07.027. Epub 2016 Sep 23.
To determine contemporary trends, patient characteristics, and outcomes for midurethral sling placement (MUS) at inpatient and ambulatory facilities from a national database.
Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 7767 women who underwent isolated MUS 2006-2012. We stratified patients by hospitalization type (outpatient vs hospitalization). Primary outcomes were 30-day complications, readmissions, and reoperations. Multivariable logistic regression was used to determine patient and surgery factors associated with adverse perioperative outcomes.
Among the 7767 women undergoing MUS, 84.3% underwent outpatient surgery (n = 6547), with greater use of outpatient facilities over time (P < .001). Overall, 3.9% of patients (n = 300) experienced one or more postoperative complications. Complications were more likely among inpatients (7.4% vs 3.2%; odds ratio [OR] 0.48, confidence interval [CI] 0.36-0.64, P < .001), with gynecologists as compared to urologists (4.4% vs 3.1%; OR 1.53, CI 1.16-2.02, P = .003), and with resident participation (5.1% vs 3.7%; OR 1.32, CI 1.01-1.73, P = .04). On multivariable analysis, outpatients were less likely to experience readmissions (0.9% vs 2.8%; OR 0.2, CI 0.09-0.56, P = .002) or undergo reoperation (0.3% vs 3.1%; OR 0.10, CI 0.02-0.38, P = .001).
Use of outpatient surgical centers for MUS is increasing, with lower rates of complications, readmissions, and reoperations compared to inpatient treatment. Although there is a difference in complications by specialty and with resident involvement, overall incidence of complications is low.
通过一个全国性数据库确定住院和门诊机构中耻骨后尿道悬吊术（MUS）的当代趋势、患者特征及治疗结果。
利用美国外科医师学会国家外科质量改进计划数据库，我们确定了2006年至2012年间接受单纯MUS手术的7767名女性。我们根据住院类型（门诊与住院）对患者进行分层。主要结局为30天并发症、再入院和再次手术。采用多变量逻辑回归分析来确定与围手术期不良结局相关的患者和手术因素。
在接受MUS手术的7767名女性中，84.3%（n = 6547）接受了门诊手术，且随着时间推移门诊机构的使用更为频繁（P <.001）。总体而言，3.9%的患者（n = 300）经历了一种或多种术后并发症。住院患者发生并发症的可能性更高（7.4%对3.2%；比值比[OR]0.48，置信区间[CI]0.36 - 0.64，P <.001），妇科医生手术的患者比泌尿科医生手术的患者并发症发生率更高（4.4%对3.1%；OR 1.53，CI 1.16 - 2.02，P =.003），有住院医师参与手术的患者并发症发生率也更高（5.1%对3.7%；OR 1.32，CI 1.01 - 1.73，P =.04）。多变量分析显示，门诊患者再入院的可能性较小（0.9%对2.8%；OR 0.2，CI 0.09 - 0.56，P =.002）或接受再次手术的可能性较小（0.3%对3.1%；OR 0.10，CI 0.02 - 0.38，P =.001）。
与住院治疗相比，门诊手术中心进行MUS手术的情况正在增加，并发症、再入院和再次手术的发生率较低。尽管不同专科以及住院医师参与手术时并发症存在差异，但总体并发症发生率较低。
