Hypothesis / aims of study
To evaluate unplanned hospital visits within 30 days of midurethral sling placement in the form of emergency department visits, inpatient admissions, or repeat surgery.
Study design, materials and methods
We included female patients who underwent midurethral sling without concomitant surgery (other than cystoscopy) and aged 20 years or older from a urology dataset including 3,431,366 individuals selected from the National Health Insurance Research Database for the year 2006 to 2010. Patients were evaluated for any unplanned hospital visits occurring within 30 days of index midurethral sling. These encounters were defined as adverse events or complications. These events or complications were categorized as: (1) outpatient surgery; (2) inpatient surgery; (3) inpatient admission; or (4) emergency department visit. Furthermore, we analyzed the risk factors associated with unplanned hospital visits after midurethral sling.
We identified 2894 female patients who underwent 2939 sling procedures between July 2007 and November 2010. Within 30 days, 210 sling procedures (7.1%) were accompanied by at least 1 unplanned hospital visit. This included 123 emergency department visits (4.2%), 72 inpatient admissions (2.4%), 22 inpatient surgeries (0.7%), and 9 outpatient surgeries (0.3%). Urinary tract infection and lower urinary tract symptoms were the most common emergency department visit diagnoses (25.6% of visits). Only two (1.5% of visits) visited emergency department due to urinary retention. Similarly, urinary tract infection and sling-related complications were the most common inpatient admission diagnoses (26.4% of admissions). Interestingly, diagnosis of psychiatric or emotional disorders occupied 16.7% of inpatient admissions. 75% of these patients had a past history of psychiatric or emotional disorders. In addition to hypertension, a patient’s individual comorbidities were not associated with unplanned hospital visits after midurethral sling. Furthermore, hospital accreditations, patients’ age, preoperative urinary tract infection and surgeons’ specialties didn’t affect unplanned hospital visits after midurethral sling.
Interpretation of results
The unplanned 30-day hospital visit rate following a midurethral sling procedure for female SUI is low at 7.1%. The majority of visits is to emergency departments, and around a quarter of these visits is for urinary tract infection or lower urinary tract symptoms. Women with the history of psychiatric or emotional disorders are prone to acute exacerbation-related inpatient admissions within 30 days of midurethral sling placement.