Association Between Hemoglobin A1c and Midurethral Sling Complications in Diabetic Women: A Cohort Study.
Journal
Female pelvic medicine & reconstructive surgery
ISSN: 2154-4212
Titre abrégé: Female Pelvic Med Reconstr Surg
Pays: United States
ID NLM: 101528690
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
entrez:
23
2
2021
pubmed:
24
2
2021
medline:
7
1
2022
Statut:
ppublish
Résumé
We aimed to evaluate the association between hemoglobin A1c (HbA1c) levels and midurethral sling (MUS) complications. This was a multihospital, retrospective cohort study from 2010 to 2020. We included all women with diabetes mellitus who underwent a synthetic mesh MUS procedure and had a preoperative HbA1c within 3 months of surgery. The primary outcome was a composite of complications, including MUS mesh exposure, surgical site granulation tissue or infection, urinary tract infection, surgical site pain beyond 6 weeks postoperatively, and MUS failure. A sensitivity analysis analyzing MUS failure alone was performed. During the study period, 109 women met the inclusion criteria. Most were White (52.2%) and had a median body mass index of 31.2 kg/m2, and 84.9% were postmenopausal. Median HbA1c was 7.2% (interquartile range, 6.3%-7.7%). Urinary tract infection was the most common complication in 12 (11.0%) women. Mesh exposure was diagnosed in 7 (6.4%) women. Seventeen (15.6%) had MUS failure. On univariate regression analysis, a higher HbA1c was associated with increased odds of composite complications (odds ratio, 1.67; 95% confidence interval, 1.20-2.32; P = 0.002) and MUS failure (odds ratio, 1.81, 95% confidence interval, 1.26-2.60; P = 0.001). On multivariate analysis, higher HbA1c levels were associated with a composite of complications and failure (P < 0.05). Based on the receiver operating characteristic curve, HbA1c greater than 8% demonstrated a specificity of 85.7% and a sensitivity of 50% for MUS failure. In diabetic patients, a higher HbA1c was associated with a higher risk of MUS complications and failure. Obtaining an HbA1c within 3 months of surgery may help with risk stratification.
Identifiants
pubmed: 33620898
doi: 10.1097/SPV.0000000000001003
pii: 01436319-202103000-00005
doi:
Substances chimiques
Glycated Hemoglobin A
0
hemoglobin A1c protein, human
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
159-162Informations de copyright
Copyright © 2020 American Urogynecologic Society. All rights reserved.
Déclaration de conflit d'intérêts
C.M. is a consultant for Scynexis, Inc and receives research support from Merck and royalties from UpToDate. M.M.W. receives royalties from UpToDate and research support from Renovia Inc. MV.O., M.B., E.A., K.J., and E.V.B. have declared they have no conflicts of interest.
Références
Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol 2004;6(Suppl 3):S3–S9.
United Nations. World Population Ageing Report 2015. Available at: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf. Accessed July 2020.
Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014;123(6):1201–1206. doi:10.1097/AOG.0000000000000286.
doi: 10.1097/AOG.0000000000000286
Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7:CD006375. doi:10.1002/14651858.CD006375.pub4.
doi: 10.1002/14651858.CD006375.pub4
Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol 2014;211(1):71.e1–71.e27. doi:10.1016/j.ajog.2014.01.030.
doi: 10.1016/j.ajog.2014.01.030
Nager C, Tulikangas P, Miller D, et al. Position statement on mesh midurethral slings for stress urinary incontinence. Female Pelvic Med Reconstr Surg 2014;20(3):123–125. doi:10.1097/SPV.0000000000000097.
doi: 10.1097/SPV.0000000000000097
Center for Disease Control and Prevention. Diabetes report. 2017. Available at: https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2017-508.pdf. Accessed July 2020.
National Diabetes Statistics Report 2020—estimates of diabetes and its burden in the United States. 2020. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed July 2020.
Stav K, Dwyer PL, Rosamilia A, et al. Risk factors of treatment failure of midurethral sling procedures for women with urinary stress incontinence. Int Urogynecol J 2010;21(2):149–155. doi:10.1007/s00192-009-1020-9.
doi: 10.1007/s00192-009-1020-9
Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377–381. doi:10.1016/j.jbi.2008.08.010.
doi: 10.1016/j.jbi.2008.08.010
Brubaker L, Norton PA, Albo ME, et al. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol 2011;205(5):498.e1–498.e6. doi:10.1016/j.ajog.2011.07.011.
doi: 10.1016/j.ajog.2011.07.011
Kenton K, Stoddard AM, Zyczynski H, et al. 5-Year longitudinal followup after retropubic and transobturator mid urethral slings. J Urol 2015;193(1):203–210. doi:10.1016/j.juro.2014.08.089.
doi: 10.1016/j.juro.2014.08.089
Daneshgari F, Moore C, Frinjari H, et al. Patient related risk factors for recurrent stress urinary incontinence surgery in women treated at a tertiary care center. J Urol 2006;176(4 Pt 1):1493–1499. doi:10.1016/j.juro.2006.06.027.
doi: 10.1016/j.juro.2006.06.027