TY - JOUR
T1 - Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence
T2 - A Medicare Claims Analysis
AU - Hall, Evelyn F.
AU - Biller, Daniel H.
AU - Buss, Joanna L.
AU - Ferzandi, Tanaz
AU - Halder, Gabriela E.
AU - Muffly, Tyler M.
AU - Nickel, Katelin B.
AU - Nihira, Mikio
AU - Olsen, Margaret A.
AU - Wallace, Shannon L.
AU - Lowder, Jerry L.
N1 - Funding Information:
Research reported in this presentation was funded by an educational program grant from Boston Scientific to the American Urogynecologic Society. The Center for Administrative Data Research provided statistical support and analysis at Washington University in St Louis. The Center for Administrative Data Research is supported by the Washington University in St Louis Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The statements in this presentation are solely the responsibility of the authors.
Funding Information:
E.F.H., D.H.B., J.L.B., T.F., G.E.H., T.M.M., K.B.N., and S.L.W. report no conflicts of interest. M.N. reports legal consultation to Ethicon. M.A.O. reports grant funding and consulting fees from Pfizer. J.L.L. serves as an expert witness and reports grant funding from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
Publisher Copyright:
© 2023 American Urogynecologic Society. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Objective: This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. Methods: This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. Results: Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). Conclusions: In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.
AB - Objective: This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. Methods: This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. Results: Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). Conclusions: In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.
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U2 - 10.1097/SPV.0000000000001362
DO - 10.1097/SPV.0000000000001362
M3 - Article
C2 - 37235803
AN - SCOPUS:85161001510
SN - 2151-8378
VL - 29
JO - Urogynecology
JF - Urogynecology
IS - 6
ER -