Department of Urology, Stanford University, 300 Pasteur Drive, Grant Building S285, Stanford, CA, 94305, USA.
Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
Int Urogynecol J. 2020 Feb;31(2):291-301. doi: 10.1007/s00192-019-04035-3. Epub 2019 Jul 12.
As the long-term complications of synthetic mesh become increasingly apparent, re-evaluation of alternative graft options for pelvic organ prolapse (POP) repairs is critical. We sought to compare the long-term reoperation rates of biologic and synthetic grafts in POP repair.
Using the California Office of Statewide Health Planning and Development database, we identified all women who underwent index inpatient POP repair with either a synthetic or biologic graft between 2005 and 2011 in the state of California. ICD-9 and CPT codes were used to identify subsequent surgeries in these patients for either recurrent POP or a graft complication.
A total of 14,192 women underwent POP repair with a biologic (14%) or synthetic graft (86%) during the study period. Women with biologic grafts had increased rates of surgery for recurrent pelvic organ prolapse (3.6% vs 2.5%, p = 0.01), whereas women with synthetic grafts had higher rates of repeat surgery for a graft complication (3.0 vs 2.0%, p = 0.02). There were no significant differences between the overall risk of repeat surgery between the groups (5.7% vs 5.6%, p = 0.79). These effects persisted in multivariate modeling.
We demonstrate in a large population-based cohort that biologic grafts are associated with an increased rate of repeat surgery for POP recurrence whereas synthetic mesh is associated with an increased rate of repeat surgery for a graft complication. These competing risks result in an equivalent overall any-cause repeat surgery rate between the groups. These data suggest that neither type of graft should be excluded from use and encourage a personalized risk assessment.
随着合成网片的长期并发症日益明显，重新评估用于治疗盆腔器官脱垂（POP）的替代移植物选择至关重要。我们旨在比较生物和合成移植物在 POP 修复中的长期再次手术率。
使用加利福尼亚州州立卫生规划和发展办公室数据库，我们确定了在加利福尼亚州于 2005 年至 2011 年间接受过索引性住院 POP 修复的所有女性，这些女性使用的是合成或生物移植物。使用 ICD-9 和 CPT 代码来识别这些患者的后续手术，以治疗复发性 POP 或移植物并发症。
在研究期间，共有 14192 名女性接受了 POP 修复，其中生物移植物（14%）或合成移植物（86%）。生物移植物的女性复发盆腔器官脱垂的手术率较高（3.6%比 2.5%，p=0.01），而合成移植物的女性因移植物并发症而再次手术的比例较高（3.0%比 2.0%，p=0.02）。两组之间再次手术的总体风险无显著差异（5.7%比 5.6%，p=0.79）。多变量建模中也存在这些影响。
我们在一项大型基于人群的队列研究中证明，生物移植物与 POP 复发的再次手术率增加相关，而合成网片与移植物并发症的再次手术率增加相关。这些相互竞争的风险导致两组之间的任何原因再次手术的总发生率相当。这些数据表明，这两种移植物都不应被排除在外，应鼓励进行个性化的风险评估。
