The Effect of Age on Outcomes of Sling Surgery for Urinary Incontinence
Published in: Journal of the American Geriatrics Society, v. 55, No. 12, Dec. 2007, p. 1927-1931
Posted on RAND.org on December 31, 2006
OBJECTIVES: To measure the effect of patient age on outcomes of sling surgery for stress urinary incontinence. DESIGN: Analysis of Medicare claims data. SETTING: Analysis of the 1999 to 2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. PARTICIPANTS: Women who underwent sling procedures between July 1, 1999, and December 31, 2000, were identified according to Common Procedural Terminology, Fourth Edition, code 57288 (sling operation for stress incontinence). Subjects were tracked for 6 months before surgery to identify preoperative comorbidities and for 12 months after surgery to assess short-term complications. Subjects were stratified for analysis at age 75. MEASUREMENTS: Bivariate analyses were conducted with patients stratified at age 75, and multivariate analyses were also conducted to identify the independent effects of patient age and comorbidities on outcomes. RESULTS: A total of 1,356 procedures were performed during the 18-month index period. This extrapolates to 27,120 procedures in all Medicare beneficiaries. At 1 year after surgery, overall outcomes in younger women (aged 65-74) were significantly better than in older women with respect to postoperative urge incontinence (20.0% vs 12.6%), treatment failure (10.5% vs 7.2%), and outlet obstruction (10.5% vs 6.6%). Older age and greater comorbidity were associated with greater risk of nonurological events (e.g., pulmonary embolism and cardiac events). CONCLUSION: Women aged 75 and older are more likely to experience postoperative urge incontinence, treatment failure, and outlet obstruction after sling surgery. Older age and comorbidities were associated with higher rates of nonurological complications.