Outcomes and Complications following Midurethral Sling: Is Race a Factor?

Objectives: To determine if there are racial disparities in surgical outcomes and complications within 30 days of midurethral sling.

Methods: In this retrospective cohort study, we identified women who underwent an isolated midurethral sling operation for stress incontinence between 2014 and 2021 using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Women were identified by the CPT code 57288, a sling operation for stress incontinence, with or without cystoscopy (52000). Women were excluded if they were under the age of 18, underwent an autologous facial sling procedure, or any other concomitant procedure. Patient demographics, stratified by racial category, were assessed to determine associations with 30-day complications. The primary outcome was surgical complications within 30 days of index surgery. Variables were compared by race using Kruskal–Wallis for continuous variables and the Chi-squared test for categorical variables in both the comparison by race and by 30-day UTI complication.

Results: 20,066 women met eligibility criteria. Table 1 shows distribution of race and patient demographics. Mean age was 54.6 years, and mean BMI was 34.1 kg/m². A higher proportion of Black or African American women had diabetes and hypertension on medications, and a higher proportion American Indian or Alaska Native women currently utilized tobacco. Most surgeries (94%) were performed as an outpatient, 86.2% were performed under general anesthesia, and 99.3% were performed by gynecologists or urologists. The only difference in 30-day complications was the incidence of stroke/CVA with neurological deficit which occurred in only one patient (Asian, Native Hawaiian or Other Pacific Islander at 0.1%), p< 0.0001. Otherwise, there were no differences, and complications were rare. Unplanned reoperation was infrequent (1.0%) with no differences between racial groups. The most frequent complication was UTI, which occurred in 3.3% of all patients undergoing midurethral sling. Black or African American were significantly less likely to acquire a UTI than Non-Hispanic White (p=0.0437), Hispanic White (p=0.0348), and American Indian or Alaska Native (p=0.0382) as shown in Table 2.

Conclusions: Surgical complications within 30 days of midurethral sling are rare. There were no race-based differences in serious 30-day complications, however low frequency of adverse events may limit analysis. Though uncommon, UTI was the most frequent complication, and was lower among Black or African American women than in Non-Hispanic White, Hispanic White, and American Indian or Alaska Native women despite the higher likelihood of comorbidities.