The Use of Urethral Slings to Treat Incontinence in Elderly Women: Is it Safe?
Valary T. Raup, MD, Alexandra Berger, MD, Julie Szymaniak, MD, Steven Chang, MD, Erica Ditkoff, MD, Elodi Dielubanza, MD
Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Background: Urethral slings are a durable treatment for stress urinary incontinence. However, there is a paucity of data on the use of slings in the very elderly. Here, we sought to evaluate the use of urethral slings to treat incontinence in female octogenarians.
Methods: The Premier Hospital Database (2003-2015) was queried using International Classification of Diseases (ICD-9) procedural codes (CPT) codes for urethral sling procedures. Slings were classified by type (retropubic, transobturator or single incision). Advanced age was defined as ≥80 years old. Prolonged length of stay (pLOS, ≥1day), prolonged operative time (pOT, ≥90 minutes), major post-operative complications, sling type, and excess cost (≥$5397) were analyzed. Each threshold represents ≥75thpercentile. Chi-squared and logistic regressions were used for analysis.
Results: A total of 143,474 women who underwent urethral sling placement were identified, with a median age of 55 years (25-85). Of these, 59,212 were ≥80 years old (41.3%). There was no association between advanced age and sling type (p=0.142). Sling placement was associated with an overall post-operative complication rate of 0.35% (503/143,474). Age ≥80 was associated with a higher rate of major post-operative complications (OR 5.99, 1.72% vs. 0.29%, p<0.0001), pOT (27.2% vs. 20.3%, p<0.0001), pLOS (32.7% vs. 21.6% p<0.0001), and excess cost (35.5% vs 24.6%, <0.0001). When controlled for pOT and Charleson Comorbidity Index (CCI), age was still associated with increased rate of major complications (OR 3.44, p<0.0001).
Conclusions: While octogenarians are more likely than younger women to experience major complications after sling placement, the observed rate was only 1.7%. In our nationally-representative sample, age >=80 was also associated with pOT, pLOS, and excess cost. Thus, urethral sling should be considered for well-selected octogenarians suffering from stress incontinence, but every effort should be made to medically optimize these patients pre-operatively, and patients should be counseled appropriately on their increased risk.
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