Presentation Authors: Ericka Sohlberg*, Kai Dallas, Christopher Elliott, Lisa Rogo-Gupta, Stanford, CA
Introduction: The use of synthetic mesh to augment pelvic organ prolapse (POP) repairs has been declining due to growing concerns regarding long-term mesh specific complications. As a result, there is interest in suitable graft alternatives such as biologic materials, which possess the theoretical benefit of improved tissue remodeling with a decreased risk of persistent vaginal erosion. Limited data however exists comparing long term outcomes of biologic and synthetic grafts when used for POP repair.
Methods: Using the California Office of Statewide Health Planning and Development database, we identified all women who underwent index inpatient POP repair with either a synthetic or biologic graft between 2005-2011 in the state of California. ICD-9 and CPT codes were used to identify subsequent surgeries in these patients for either recurrent POP or a graft complication.
Results: A total of 14,192 women underwent POP repair with a biologic (14%) or synthetic graft (86%) during the study period. In the cohort, there was an overall associated repeat surgery rate of 5.6%. With a median follow-up of 2 years, women with biologic grafts had an increased risk of surgery for recurrent pelvic organ prolapse compared with synthetic mesh (3.6% vs. 2.5%, p=0.01). Conversely, women with synthetic grafts had a higher risk of repeat surgery for a graft complication (3.0% vs. 2.0%, p=0.02). There were no significant differences between the overall risk of repeat surgery in patients who received biologic versus synthetic grafts during the follow-up period (5.7% vs. 5.6%, p=0.79) (Figure 1).
Conclusions: We demonstrate in a large population-based cohort that biologic grafts are associated with an increased risk of repeat surgery for a POP recurrence while synthetic mesh is associated with an increased risk of repeat surgery for a graft related complication. These competing risks result in an equivalent overall associated repeat surgery rate between the groups suggesting that neither synthetic nor biologic grafts should be excluded based on their risk profile.
Source of Funding: Valley Medical Foundation