Related Experiment Video
Updated: Mar 21, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective
Andrew J Cohen1, Vignesh T Packiam1, Charles U Nottingham1
1Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL.
Objective:
To determine 30-day complications, risk of readmission, and reoperation for midurethral slings (MUS).
Methods:
The National Surgical Quality Improvement Program database from 2006 to 2013 was queried for MUS alone by excluding concurrent reconstructive, urologic, or gynecologic procedures. We assessed baseline characteristics, 30-day perioperative outcomes and 30-day readmission. Logistic regression analysis identified risk factors for the frequent complications.
Results:
There were 8772 women who underwent MUS, of which 3830 (43.7%) and 4942 (56.3%) were performed by urologists and gynecologists, respectively. Patients of urologists were older, had higher frailty, and were more likely diabetic (all P < .05). Patients of gynecologists were more likely to have resident involvement compared to urologists (16.4% vs 11.2%, P < .001). Mean operative time was shorter for urologists compared to gynecologists (35.6 ± 29.2 minutes vs 38.1 ± 34.3 minutes, P < .001). The overall 30-day rate of any complication was 3.52%. Urinary tract infection (UTI) occurred in 2.2% vs 3.5% of the urologic and gynecologic patients, respectively (P=.001). After adjusting for frailty, body mass index, steroid use, age, operative time, and residency involvement, gynecologic performed surgery incurred an increased risk of UTI (OR 1.67, 95% CI 1.27-2.19; P=.001). Sixty-five (0.90%) patients were readmitted within 30 days, most commonly due to urinary symptoms. Sling revision for urinary obstruction occurred in 15 patients; 10 underwent repair of the bladder, urethra, or vagina.
Conclusion:
To our knowledge, we present the largest American cohort of MUS 30-day outcomes to date, stratified by specialty of performing surgeon. Overall, morbidity is low. UTI is the most common complication, and occurs at increased frequency for patients of gynecologists.
Insights
Midurethral slings (MUS) have low overall complication rates. However, gynecologist-performed MUS procedures show a higher risk of urinary tract infections (UTIs) compared to urologist-performed procedures.
Area of Science:
- Urology
- Gynecology
- Surgical Outcomes
Background:
- Midurethral slings (MUS) are a common surgical treatment for stress urinary incontinence.
- Understanding the 30-day outcomes and risk factors associated with MUS procedures is crucial for patient safety and quality improvement.
Purpose of the Study:
- To evaluate 30-day complications, readmission rates, and reoperation rates following midurethral sling procedures.
- To compare outcomes based on the surgical specialty (urology vs. gynecology) performing the MUS procedure.
Main Methods:
- A retrospective analysis of the National Surgical Quality Improvement Program database (2006-2013).
- Inclusion criteria focused on MUS procedures performed alone, excluding concurrent surgeries.
- Logistic regression was used to identify risk factors for complications.
Main Results:
- A total of 8772 women underwent MUS procedures, with 43.7% performed by urologists and 56.3% by gynecologists.
- The overall 30-day complication rate was 3.52%. Urinary tract infection (UTI) was the most common complication.
- Gynecologist-performed surgeries were associated with a significantly increased risk of UTI (OR 1.67, 95% CI 1.27-2.19) after adjusting for confounding factors.
Conclusions:
- Midurethral sling procedures demonstrate low overall morbidity within 30 days.
- Urinary tract infection is the most frequent complication, occurring more often after procedures performed by gynecologists.
- These findings highlight the importance of surgeon specialty in the risk profile of MUS procedures.
