JAMA: Women face increased risk for second vaginal mesh surgery 10 years after implant

Amid a raft of litigation over vaginal mesh implants, a new study shows that women outfitted with the device often need another operation 10 years after getting the slings for urinary incontinence.

Researchers at Ontario, Canada's Western University looked at data on 59,887 women who had mesh slings implanted by about 1,000 different surgeons between 2002 and 2012, and found that after 5 years, 2.2% of women required reoperation. And when women were followed for 10 years, that figure shot up to 3.3%, creating a one in 30 chance that a woman with a mesh implant will have to undergo revision surgery or reoperation, Reuters reports. The team published their findings in a recent issue of JAMA Surgery.

Who performed the original mesh surgery could make a difference, researchers noted in the JAMA Surgery study. A surgeon's specialty, such as whether they were gynecologists or urologists, did not affect results. But surgeons who performed more cases were associated with better outcomes for patients, with the top 25% of surgeons by case volume outperforming the rest. And patients of lower-volume surgeons have a 37% greater chance of a complication further down the line.

Still, researchers acknowledged that there were some holes in the data. The team did not look at the severity of a patient's incontinence presurgery, or their smoking history or type of mesh used in the procedures. The study was also limited to complications serious enough to require repeat surgeries, Reuters notes.

But the findings raise important questions about who is performing the surgery. Women should make sure they know about their surgeon's past experience, lead researcher Dr. Blayne Welk of Western University said in an email to Reuters.

Dr. Quoc-Dien Trinh

The study also underscores the importance of finding surgeons who have done high volumes of the procedure, which might be difficult for patients in less populated areas, Dr. Quoc-Dien Trinh of Brigham and Women's Hospital, told the news outlet.

"This paper shows that there is merit in asking that question specifically in the context of mesh surgeries, and it has been shown to be a generally reliable metric of surgical quality care," Trinh said, as quoted by Reuters. "Ultimately, patients need to strike a balance between convenience and quality."

- here's the JAMA Surgery abstract
- read the Reuters story

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