Michelle E Van Kuiken1, Shoujun Zhao1, Kenneth Covinsky2, John Boscardin3, Emily Finlayson4, Anne M Suskind1. 1. Department of Urology, University of California, San Francisco, California. 2. Division of Geriatric Medicine, University of California, San Francisco, California. 3. Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California. 4. Department of Surgery, University of California, San Francisco, California.
Abstract
PURPOSE: Sling surgery is the gold standard treatment for stress urinary incontinence in women. While data support the use of sling surgery in younger and middle-aged women, outcomes in older, frail women are largely unknown. MATERIALS AND METHODS: Data were examined for all Medicare beneficiaries ≥65 years old who underwent sling surgery with or without concomitant prolapse repair from 2014 to 2016. Beneficiaries were stratified using the Claims-Based Frailty Index (CFI) into 4 categories: not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), mildly frail (0.25 ≤CFI <0.35) and moderately to severely frail (CFI ≥0.35). Outcomes included rates and relative risk of 30-day complications, 1-year mortality and repeat procedures for persistent incontinence or obstructed voiding at 1 year. RESULTS: A total of 54,112 women underwent sling surgery during the study period, 5.2% of whom were mildly to moderately to severely frail. Compared to the not frail group, moderately to severely frail beneficiaries demonstrated an increased adjusted relative risk (aRR) of 30-day complications (56.5%; aRR 2.5, 95% CI: 2.2-2.9) and 1-year mortality (10.5%; aRR 6.7, 95% CI: 4.0-11.2). Additionally, there were higher rates of repeat procedures in mildly to severely frail beneficiaries (6.6%; aRR 1.4, 95% CI: 1.2-1.6) compared to beneficiaries who were not frail. CONCLUSIONS: As frailty increased, there was an increased relative risk of 30-day complications, 1-year mortality and need for repeat procedures for persistent incontinence or obstructed voiding at 1 year. While there were fewer sling surgeries in performed frail women, the observed increase in complication rates was significant. Frailty should be strongly considered before pursuing sling surgery in older women.
PURPOSE: Sling surgery is the gold standard treatment for stress urinary incontinence in women. While data support the use of sling surgery in younger and middle-aged women, outcomes in older, frail women are largely unknown. MATERIALS AND METHODS: Data were examined for all Medicare beneficiaries ≥65 years old who underwent sling surgery with or without concomitant prolapse repair from 2014 to 2016. Beneficiaries were stratified using the Claims-Based Frailty Index (CFI) into 4 categories: not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), mildly frail (0.25 ≤CFI <0.35) and moderately to severely frail (CFI ≥0.35). Outcomes included rates and relative risk of 30-day complications, 1-year mortality and repeat procedures for persistent incontinence or obstructed voiding at 1 year. RESULTS: A total of 54,112 women underwent sling surgery during the study period, 5.2% of whom were mildly to moderately to severely frail. Compared to the not frail group, moderately to severely frail beneficiaries demonstrated an increased adjusted relative risk (aRR) of 30-day complications (56.5%; aRR 2.5, 95% CI: 2.2-2.9) and 1-year mortality (10.5%; aRR 6.7, 95% CI: 4.0-11.2). Additionally, there were higher rates of repeat procedures in mildly to severely frail beneficiaries (6.6%; aRR 1.4, 95% CI: 1.2-1.6) compared to beneficiaries who were not frail. CONCLUSIONS: As frailty increased, there was an increased relative risk of 30-day complications, 1-year mortality and need for repeat procedures for persistent incontinence or obstructed voiding at 1 year. While there were fewer sling surgeries in performed frail women, the observed increase in complication rates was significant. Frailty should be strongly considered before pursuing sling surgery in older women.
Authors: Anne M Suskind; Samuel R Kaufman; Rodney L Dunn; John T Stoffel; J Quentin Clemens; Brent K Hollenbeck Journal: Int Urogynecol J Date: 2012-06-06 Impact factor: 2.894
Authors: Mohammad Abufaraj; Tianlin Xu; Chao Cao; Abdelmuez Siyam; Ula Isleem; Abdulla Massad; Francesco Soria; Shahrokh F Shariat; Siobhan Sutcliffe; Lin Yang Journal: Am J Obstet Gynecol Date: 2021-03-13 Impact factor: 8.661
Authors: Dae Hyun Kim; Sebastian Schneeweiss; Robert J Glynn; Lewis A Lipsitz; Kenneth Rockwood; Jerry Avorn Journal: J Gerontol A Biol Sci Med Sci Date: 2018-06-14 Impact factor: 6.053
Authors: Andrew R Medendorp; Hui Liu; Lorna Kwan; Anne M Suskind; Una J Lee; Katherine A Amin; Mark S Litwin; Jennifer T Anger Journal: J Urol Date: 2021-04-01 Impact factor: 7.450
Authors: Jennifer T Anger; Aviva E Weinberg; Michael E Albo; Ariana L Smith; Ja-Hong Kim; Larissa V Rodríguez; Christopher S Saigal Journal: Urology Date: 2009-06-07 Impact factor: 2.649
Authors: Anne M Suskind; Shoujun Zhao; Farnoosh Nik-Ahd; W John Boscardin; Kenneth Covinsky; Emily Finlayson Journal: J Am Geriatr Soc Date: 2021-04-05 Impact factor: 5.562