Introduction: Autologous fascial slings (AFS) are a valuable surgical option for the treatment of female stress urinary incontinence (SUI). In light of the Food and Drug Administration’s advisory notifications, we hypothesized that there may be resurgence of AFS over synthetic slings. We sought to quantify the utilization of AFS performed in a large population-based cohort.
Methods: All women undergoing a sling procedure for SUI in California between January 1, 2013 through December 31, 2018 were identified using the Office of Statewide Health Planning and Development data sets (CPT 57288). AFS cases were identified by the presence of a fascial harvest code (rectus or fascia lata, CPT 20920, 20922, 15769, 29022, 20926, 15770, 15760). Patient demographics and the surgical facility were identified.
Results: A total of 45,919 slings were placed in 41,374 unique women (mean age 56.5 years). Overall, 404 (0.9%) were AFS and of these, 132 were predated by at least one prior sling placement (32.7%). A total of 1,201 synthetic sling cases were predated by a prior sling placement. Overall, 40,104, 1,181, 83, three and two women underwent one, two, three, four and five sling placements, respectively. There were 299 unique facilities where slings were placed; however, fascial slings were only placed at 35 unique sites. Of the 404 fascial slings placed, 311 (77.0%) were placed at three unique academic centers.
Conclusions: Though critical in the armamentarium of surgical treatment of female SUI, AFS are rarely performed. Although the authors acknowledge that some fascial sling cases may not have been captured due to the lack of a fascial harvest code, our reported rates here are actually consistent with the limited literature on the topic (1). Further supporting these findings, our results also demonstrated that the majority of AFS procedures were concentrated to a small cadre of academic centers. With the limited number of centers where this procedure is performed, our data portends the likely importance of referral to a tertiary center for placement of autologous fascial slings, if indicated. 1) James MB, et al. Sling Procedures for the Treatment of Stress Urinary Incontinence: Comparison of National Practice Patterns between Urologists and Gynecologists. J Urol. 2017 Dec;198(6):1386-1391.
.jpg)
.jpg)