Cartier Sophie, Cerantola Gina-Marie, Leung Alexander A, Brennand Erin
Département d'obstétrique-gynécologie, Université de Montréal, Montréal, Québec, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Int Urogynecol J. 2023 May;34(5):981-992. doi: 10.1007/s00192-022-05426-9. Epub 2022 Dec 20.
Undesired outcomes after mid-urethral sling (MUS), such as mesh exposure or surgical failure, can necessitate further procedures. The objective of this review is to evaluate the association between surgeon operative volume and the risk of reoperation after MUS.
Eligible studies were selected through an electronic literature search from database and references of the studies included. Databases were searched for original studies reporting on the MUS procedure, reoperation, and operative volume. Random effects models were used to estimate the pooled OR of reoperation according to surgeon volume. Outcomes were divided into two categories: mesh removal and/or revision and subsequent surgery for treatment of SUI.
A total of 2,304 abstracts were screened, and 51 studies were assessed through full-text reading. Seven studies were included in the systematic review. High-volume and low-volume surgeons were defined differently in various studies. The odds ratio of the mesh removal/revision procedure was 1.26 (95%CI 1.03-1.53) among those who received their surgery from a low-volume surgeon compared with those who received their surgery from a high-volume surgeon as defined by the studies. The odds ratio of repeated incontinence procedures was 1.18 (95% CI 1.01-1.37).
The odds of a repeat incontinence procedure appear higher if the surgery is performed by a low-volume surgeon, although these results need to be interpreted with caution as the definition of low-volume vs high-volume surgeon varied between studies. As such, operative volume should be included in surgical reporting, and future research should utilize surgical volume as either a continuous exposure or a standardized value of low- vs high-volume MUS surgeons.
尿道中段吊带术（MUS）后出现的不良后果，如网片暴露或手术失败，可能需要进一步手术。本综述的目的是评估外科医生手术量与MUS术后再次手术风险之间的关联。
通过电子文献检索从数据库及纳入研究的参考文献中筛选合格研究。在数据库中检索关于MUS手术、再次手术和手术量的原始研究。采用随机效应模型根据外科医生手术量估计再次手术的合并比值比。结果分为两类：网片取出和/或修复以及后续治疗压力性尿失禁（SUI）的手术。
共筛选2304篇摘要，通过全文阅读评估51项研究。系统评价纳入7项研究。不同研究对高手术量和低手术量外科医生的定义不同。根据研究定义，接受低手术量外科医生手术的患者与接受高手术量外科医生手术的患者相比，网片取出/修复手术的比值比为1.26（95%可信区间1.03 - 1.53）。重复尿失禁手术的比值比为1.18（95%可信区间1.01 - 1.37）。
如果手术由低手术量外科医生进行，再次进行尿失禁手术的几率似乎更高，尽管由于不同研究对低手术量与高手术量外科医生的定义不同，这些结果需要谨慎解读。因此，手术量应纳入手术报告中，未来研究应将手术量作为连续暴露因素或低手术量与高手术量MUS外科医生的标准化值来使用。
