Hypothesis / aims of study
We need more data about the incidence of severe complication after surgical repair for urinary incontinence (UI) or pelvic organ prolapse (POP) in women.
This study is looking to assess the rate of complications following a surgery urinary incontinence or pelvic organ prolapse in women with or without meshes, using data from the IMD and hospital charts.
Study design, materials and methods
In France, all surgery and complications during an hospitalization are coded by the Information Medical Department (IMD) using the International Statistical Classification of Diseases (ICD) and the Common Classification of Medical Acts (CCAM). This is a retrospective and observational study, in a single-center (teaching hospital) from January 2011 to December 2017. We included all women who have received, according to the ICD or CCAM classification, a surgery surgery for urinary incontinence or pelvic organ prolapse. We included mid-urethra sling (MUS) or colposuspension, vaginal repair surgery with or without mesh, abdominal or laparoscopic repair surgery, and endoanal surgery. Artificial sphincters, balloons and periurethral injections were excluded.
Complications were identified using ICD and CCAM classification and systematic review of all hospital charts. The Clavien-Dindo classification has five grades. A grade III complication require a surgical, endoscopic or radiological intervention (grade IIIa intervention not under general anesthesia and grade IIIb under general anesthesia). A grade IV complication need a life threatening complication and a grade V complication is the death of a patient. We considered only grade III or above, as per the Clavien-Dindo classification, and hospitalization in an Intensive Care Unit within 60 days of surgery. Failure or recurrence of incontinence or prolapse were not considered as a severe complication.
Interpretation of results
Over 7 years thanks to the ICD and CCAM classifications, we have been able to assemble 693 surgery of the prolapse, or to address urinary incontinence with or without meshes. We found 9.8% of the complications grade III and above. Our method does not include complications treated in another center. We were able to underestimate the rate of complications of the pelvic floor repaired surgeries.