Factors associated with ambulatory surgery success after mid-urethral sling placement: Development of a predictive...

Outpatient surgery is now common in surgical procedure for stress urinary incontinence especially mid-urethral slings (MUS). However, this type of management requires a better selection of patients. The objective of this study was to find predictive factors and a reliable predictive model for the success of outpatient MUS surgery.

We carried out a single-center retrospective study between 2013 and 2018 including female patients planned as outpatient for MUS placement for urinary incontinence. Predictive factors and a preoperative predictive model of outpatient success for this surgery were assessed.

Overall, 84 patients were included, the mean (standard deviation) age and body mass index (BMI) were respectively 51.9 years (10.9) and 24.7 (4.2). 58 (69%) presented a successful outpatient procedure. In the multivariate analysis, BMI, postoperative visual analogic scale, use of tramadol, preoperative maximum urine flow (Qmax) and surgery duration were predictive of outpatient success (respectively OR [95%CI]= 0.8[0.7-0.9], 0.6[0.4-0.9], 0.1[0.1-0.7], 2.1[1.2-4.2] and 0.9[0.8-0.9]). A pre-operative predictive model including BMI and Qmax had an area under the curve of 0,71. The best performing threshold for the BMI was 24.5kg/m² and for Qmax was 29.5ml/sec with an 86% prediction rate for outpatient success.

We evidenced that low BMI, high preoperative Qmax, short operating time, low postoperative pain, and no use of tramadol were predictive of successful ambulatory care. In addition, a model combining BMI and urinary flow was highly predictive of ambulatory success for patients who underwent MUS placement. External validation is needed.