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Risk factors for mesh erosion after female pelvic floor reconstructive surgery: a systematic review and meta‐analysis
Author(s) -
Deng Tuo,
Liao Banghua,
Luo Deyi,
Shen Hong,
Wang Kunjie
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13158
Subject(s) - medicine , odds ratio , confidence interval , hysterectomy , concomitant , meta analysis , cochrane library , reconstructive surgery , diabetes mellitus , surgery , gynecology , endocrinology
Objectives To explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. Materials and Methods A systematic literature search of the PubMed, Embase, Cochrane Library, Chinese Biomedical Literature ( CBM ), China National Knowledge Infrastructure ( CNKI ) and Chinese Science and Technology Periodical ( VIP ) databases was performed to identify studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratios ( OR s) with 95% confidence intervals ( CI s) were calculated to assess the strength of associations between the factors and mesh erosion. Results In all, 25 studies containing 7 084 patients were included in our systematic review and meta‐analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in older vs younger patients ( OR 0.96, 95% CI 0.94–0.98), more parities vs less parities ( OR 1.27, 95% CI 1.07–1.51), the presence of premenopausal/oestrogen replacement therapy ( ERT ) ( OR 1.36, 95% CI 1.03–1.79), diabetes mellitus ( OR 1.87, 95% CI 1.35–2.57), smoking ( OR 2.35, 95% CI 1.80–3.08), concomitant pelvic organ prolapse ( POP ) surgery ( OR 0.37, 95% CI 0.16–0.84), concomitant hysterectomy ( OR 1.46, 95% CI 1.03–2.07), preservation of the uterus at surgery ( OR 0.22, 95% CI 0.08–0.63), and surgery performed by senior vs junior surgeons ( OR 0.42, 95% CI 0.30–0.58). Conclusion Our study indicates that younger age, more parities, premenopausal/ ERT , diabetes mellitus, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion.