Trends and Reinterventions in the Surgical Management of Stress Urinary Incontinence among Female Medicare Beneficiaries
© 2016 American Urological Association Education and Research, Inc.Introduction: We compare the use of bulking agents and slings for the treatment of stress urinary incontinence among female Medicare beneficiaries. Methods: We analyzed data from a 5% national random sample of Medicare claims from 2000 to 2011. Female beneficiaries who underwent a sling or bulking agent procedure were identified based on CPT-4 and ICD-9 procedure codes. Statistical analysis for categorical data determined differences in the distribution of patient demographics and comorbidities. The 90-day adverse events and reinterventions were compared between treatment groups. Time to event analysis was used to determine freedom from reintervention after therapy. Results: We identified 21,134 and 3,475 patients treated with sling and bulking procedures, respectively. There was a 29.7% increase in the number of sling procedures and a 59.5% decrease in bulking procedures from 2001 to 2011. Patients treated with bulking agents had higher rates of diabetes, cardiovascular disease, heart failure and renal failure (p <0.01). The 90-day adverse events after both procedures were rare, with the exception of urinary retention, which was increased in women treated with a sling but frequent in both groups (sling 11.3%, bulking agent 8.4%; p <0.01). A smaller proportion of patients who underwent sling surgery had reinterventions (repeat sling 7.4%, bulking agent 38.2%; p <0.01). Overall 53.2% of the patients treated with a sling and 76.3% treated with bulking agents who underwent subsequent procedures were treated with the same procedure at the first intervention. Conclusions: Sling and bulking procedures are safe in terms of short-term performance, although the rates of retention were high in both groups. Patients treated with reinterventions tend to repeat the same therapy instead of converting to another procedure.
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