经尿道中段吊带手术后吊带修复的预测因素：病例对照研究。

Predictors of sling revision after mid-urethral sling procedures: a case-control study.

机构信息

Division of Urogynecology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.

School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

出版信息

BJOG. 2019 Feb;126(3):419-426. doi: 10.1111/1471-0528.15470. Epub 2018 Oct 24.

DOI:10.1111/1471-0528.15470

PMID:30220104

Abstract

OBJECTIVE

To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal.

DESIGN

Case-control study.

SETTING

Tertiary academic centre in Canada.

POPULATION

One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio).

METHODS

Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors.

RESULTS

The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here.

CONCLUSIONS

Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal.

TWEETABLE ABSTRACT

Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery.

摘要

目的

确定需要进行经尿道中段吊带（MUS）修正/移除的并发症的患者特征和手术因素。

设计

病例对照研究。

地点

加拿大的一所三级学术中心。

人群

2005 年至 2016 年间，107 名接受 MUS 修正/移除的女性与 214 名通过索引 MUS 手术日期（2:1 比例）进行匹配的对照组进行了匹配。

方法

通过手动电子和纸质图表审查获取患者和手术因素的数据。使用三组预定义的简单和多变量逻辑回归模型进行拟合：（1）检查原发性手术治疗后 MUS 修正的先前报告的危险因素；（2）确定需要修正/移除的 MUS 并发症的术前预测因素；（3）在调整潜在混杂因素后，确定与该结果相关的手术因素。

主要观察指标

患者和手术因素的粗比和调整比值比（OR）及 95%置信区间（95%CI）。

结果

MUS 修正的中位数时间为 153 天（四分位距，IQR 49-432 天）。当前吸烟状态（OR 2.29，95%CI 1.13-4.63，P = 0.03）、曾行子宫切除术（OR 3.88，95%CI 2.02-7.46，P < 0.01）和在索引 MUS 手术时同时行盆腔器官脱垂手术（OR 2.63，95%CI 1.32-5.52，P < 0.01）与 MUS 修正/移除的需要独立相关。吊带类型（闭孔 versus 经耻骨）、张紧方法（咳嗽 versus 器械上）、麻醉类型和估计失血量在本研究中与该结果无关。