Poorer sling surgery outcomes reported in older women

Older women can expect more complications from sling surgery and less favorable outcomes than can younger patients, according to a retrospective study of 1,356 sling procedures. The data were derived from Medicare claims.

Women who were age 75 years or older at the time of the surgery were 48% more likely to suffer non-urologic complications than were women who underwent the procedure between the ages of 56 and 74 years. Women in the older age group also were 24% more likely to have a new diagnosis of urge incontinence within 1 year of sling surgery and were slightly more likely to experience treatment failure than were women in the younger group, researchers reported at the AUA annual meeting.

"We would not necessarily tell older patients not to have slings," first author Jennifer Anger, MD, of the UCLA David Geffen School of Medicine, told Urology Times. "We need to have appropriate counseling so patients recognize and are willing to take those risks."

Dr. Anger and colleagues analyzed Medicare data on a 5% random sample of women who had the sling procedure performed between July 1, 1999, and Dec. 31, 2000. Patients were tracked for 6 months before surgery to identify preoperative comorbidities and were followed for 12 months after surgery to assess short-term complications. The 1,356 slings recorded represent 27,120 procedures during the 18-month study period.

Dr. Anger said postoperative claims data show a clear trend toward less favorable outcomes with increasing age at surgery. Women age 75 years and older had worse outcomes in terms of non-urologic complications, new diagnoses of urge incontinence, treatment failure, and outlet obstruction.

Women age 75 years and older had rates of urinary obstruction similar to those of women between the ages of 70 and 74 years and about one-third more urinary obstructions than did women between 65 and 69 years of age.