umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Decisions to use surgical mesh in operations for pelvic organ prolapse: a question of geography?
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Gynop-registret, Norrlands universitetssjukhus, Umeå, Sweden.ORCID iD: 0000-0002-3250-3708
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.ORCID iD: 0000-0002-3250-3708
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
2019 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 30, no 9, p. 1533-1539Article in journal (Refereed) Published
Abstract [en]

Introduction and hypothesis: Surgical mesh can reinforce damaged biological structures in operations for genital organ prolapse. When a method is new, scientific information is often contradictory. Individual surgeons may accept different observations as useful, resulting in conflicting treatment strategies. Additional scientific information should lead to increasing convergence.

Methods: Based on data from the Swedish National Quality Register of Gynecological Surgery, all patients who underwent their first recurrent anterior compartment prolapse operation between 2006 and 2017 were included (2758 patients). Surgical mesh was used in 56.5%. We analyzed inter-county disparities in and patterns of mesh use over 12 years. To minimize confounding, we selected a group of highly comparable patients where similar decision patterns could be expected.

Results: The use of mesh differed between counties by a factor of 11 (8.6-95.3%). Counties with low use of mesh continued with low use and counties with high use continued with high use.

Conclusions: Decisions regarding how to interpret existing scientific information about mesh implants in the early years of mesh use have led to "communities of practice" highly influenced by geographical factors. For 12 years, these groups have made disparate decisions and upheld them without measurable change toward consensus. The scientific learning process has stopped-despite the abundance of new publications and the steady supply of new types of mesh. Ongoing disparity in surgeons' choices in comparable patients has an adverse effect on clinical care. For the patient, this represents 12 years of a geographical lottery concerning whether mesh is used or not.

Place, publisher, year, edition, pages
Springer London, 2019. Vol. 30, no 9, p. 1533-1539
Keywords [en]
Quality control, Surgical decision-making, Surgical mesh, Surgical learning
National Category
Surgery Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-163655DOI: 10.1007/s00192-018-3788-yISI: 000482489100019PubMedID: 30343378OAI: oai:DiVA.org:umu-163655DiVA, id: diva2:1367065
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-10-31Bibliographically approved

Open Access in DiVA

fulltext(1476 kB)13 downloads
File information
File name FULLTEXT02.pdfFile size 1476 kBChecksum SHA-512
973601734b6d3b49c9bf6bac70271342f3a23e80c973113411089392d9b3674a28e62e04835a2caf52478a1ab5a2ca40711b82ea7a72509fd559ddb37fe5a313
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Nüssler, Emil KarlNüssler, EmilLöfgren, Mats

Search in DiVA

By author/editor
Nüssler, Emil KarlNüssler, EmilEskildsen, Jacob KjaerLöfgren, Mats
By organisation
Obstetrics and Gynecology
In the same journal
International Urogynecology Journal
SurgeryObstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 14 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 62 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf