Effect of Postoperative Weight Change on Outcomes After Midurethral Sling.

IMPORTANCE

Midurethral sling surgery is the gold standard surgical treatment for stress urinary incontinence, and many patients experience weight changes over time. The effect of these changes on long-term outcomes remains unclear.

OBJECTIVE

The objective of this study was to evaluate the association between postoperative weight change of at least 10% and long-term retreatment and complication outcomes after midurethral sling surgery.

STUDY

DESIGN

This retrospective cohort study included adult women undergoing primary midurethral sling surgery for stress urinary incontinence between 2008 and 2019 within an integrated health care system. Eligible patients had at least 5 years of follow-up and longitudinal weight data. Postoperative weight change was categorized as stable (<10%) or at least 10% (loss, gain, or fluctuation). The primary outcome was retreatment for stress urinary incontinence identified using procedural codes. Secondary outcomes included sling-related complications. Multivariable logistic regression adjusted for age, body mass index, and comorbidities. Time to retreatment was assessed using Kaplan-Meier analysis.

RESULTS

Among 6,924 patients, 44.9% experienced at least 10% weight change. Overall, 5.2% underwent retreatment. Retreatment rates were lowest in the stable group (4.5%) and higher with weight gain (6.4%). Complications occurred in 16.5% and were lowest in the stable group (14.4%) and highest in the fluctuating group (26.4%). After adjustment, postoperative weight gain was independently associated with increased odds of stress urinary incontinence retreatment (adjusted odds ratio [aOR], 1.53; 95% CI, 1.17-1.99). Weight fluctuation had the strongest association with postoperative complications (aOR, 2.07; 95% CI, 1.49-2.84), followed by weight loss (aOR, 1.40; 95% CI, 1.18-1.65) and weight gain (aOR, 1.29; 95% CI, 1.09-1.52). Weight fluctuation was also independently associated with de novo urgency incontinence (aOR, 1.55; 95% CI, 1.12-2.12).

CONCLUSIONS

Significant postoperative weight change may be associated with an increased risk of retreatment and complications. A better understanding of weight change patterns may improve long-term outcomes.