Post-hospital syndrome predicts poor postoperative outcomes and increased cost following transvaginal midurethral sling placement

  • Spencer T. HartEmail author
  • Marc Nelson
  • Eric Kirshenbaum
  • Yufan Chen
  • Elizabeth R. Mueller
  • Gopal Gupta
Original Article


Introduction and hypothesis

Post-hospital syndrome (PHS), a 90-day period of health vulnerability related to physiologic stressors following recent inpatient admission, has been observed in surgical and non-surgical patients. We aim to explore its effects on readmission and complication rates in patients undergoing elective female mid-urethral sling placement for the treatment of stress urinary incontinence.


The Healthcare Cost and Utilization Project State Inpatient Database, State Emergency Department Database, and State Ambulatory Surgery Database for Florida between 2009 and 2014 were linked and utilized. Patients were identified as having undergone an outpatient mid-urethral sling placement with or without cystoscopy by CPT code. The primary exposure was PHS, defined as any inpatient admission within 90 days of mid-urethral sling placement. Patients with inpatient hospitalizations within 1 year of sling procedure were categorized based on timing of prior admission and analyzed. The primary outcomes were 30-day hospital readmission, rates of postoperative ED visits, minor/major complications rates, and overall 30-day cost. A multivariable logistic regression model was fit to assess independent predictors of adverse surgical outcomes.


A total of 17,081 female patients who underwent mid-urethral sling procedures were identified. Patients with PHS were at higher risk for 30-day readmission [OR: 5.36 (IQR: 3.61–7.93); p < 0.005], 30-day ED visits [OR: 2.38 (IQR: 1.75–3.25); p < 0.005], major complications [OR: 6.22 (IQR: 4.67–8.29); p < 0.005], and minor complications [OR: 4.62 (IQR: 3.77–5.67); p < 0.005]. This risk was time dependent in nature with a decreasing risk profile the further surgery was from index hospitalization. Furthermore, PHS patients were more likely to incur an increased cost burden with an average 30-day increased cost of $705.80.


Hospitalization within 90 days prior to mid-urethral sling placement is a risk-adjusted, independent predictor of increased rates of 30-day readmission rates, 30-day ED visits, 30-day minor/major complications, and increased hospital-related cost. Clinical and surgical outcomes may be improved with consideration of prior hospitalizations in determining the timing of mid-urethral sling placement for stress urinary incontinence.


Mid-urethral sling Post-hospital syndrome Outcomes 



Emergency department


Charlson Comorbidity Index


Clinical Classification Software


Current Procedural Terminology


Deep venous thrombosis


The Healthcare Cost and Utilization Project


International Classification of Disease, version 9


Myocardial infarction


Mid-urethral sling


Odds ratio


Pulmonary embolism




Post-hospital syndrome


State Ambulatory Surgery Database


State Inpatient Database


Urinary tract infection


Compliance with ethical standards

Conflicts of interest

Elizabeth R Mueller:

Astellas Pharma: investigator funding.

Boston Scientific: advisory board.

Butler-Snow/Ethicon: legal consultation.

UpToDate: royalties.

Spencer Hart, Marc Nelson, Eric Kirshenbaum, and Gopal Gupta have no financial disclosures or conflicts of interest.

Supplementary material

192_2019_4009_MOESM1_ESM.docx (14 kb)
Supplementary Table 1 (DOCX 14 kb)


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Spencer T. Hart
    • 1
    Email author
  • Marc Nelson
    • 1
  • Eric Kirshenbaum
    • 1
  • Yufan Chen
    • 2
  • Elizabeth R. Mueller
    • 1
    • 2
  • Gopal Gupta
    • 1
  1. 1.Department of UrologyLoyola University Medical CenterMaywoodUSA
  2. 2.Department of Obstetrics/GynecologyLoyola University Medical CenterMaywoodUSA

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