Morbidity and mortality of incontinence surgery in elderly women: an analysis of Medicare data.
OBJECTIVE
Our purpose was to examine length of hospital stay, complications, morbidity, and mortality associated with surgery for urinary incontinence in women > 65 years old.


METHODS
Data obtained from Medicare billing forms (HCFA form 1450, UB-82, UB-92) in the Medicare Provider Analysis and Review Record database for surgical procedures done for incontinence (international Classification of Diseases, Ninth Revision, codes 59.3 to 59.79) from 1984 to 1991 were reviewed. Comorbidities and reasons for readmission were extracted from secondary diagnosis codes.


RESULTS
There wee 66,478 patients in the cohort. The mean and median ages were 71 years. The 30-day surgical mortality was 0.33%. Length of stay and mortality increased linearly with age. Acute events associated with death were myocardial infarction (14.2% of deaths), cerebrovascular accident (stroke) (14.6%), pulmonary embolism or deep vein thrombosis (9.7%), and pneumonia (2.7%). Patients who died had higher rates of diabetes and heart failure but not of hypertension. The 30-day readmission rate was 4.8% with higher rates in patients > 80 years old. Urinary tract infection (12.2%), hypertension (16%), and unspecified complications (9%) were the most frequent diagnoses on readmissions. Myocardial infarction, pulmonary embolism, cerebrovascular accident, deep vein thrombosis, and pneumonia each occurred in only 1%.


CONCLUSIONS
Incontinence surgery is safe in the "young elderly." Those > 80 years old and with certain chronic illness should be counseled about increased risks.
Sultana
C J
CJ
Department of Obstetrics and Gynecology/Reproductive Biology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
Campbell
J W
JW
Pisanelli
W S
WS
Sivinski
L
L
Rimm
A A
AA
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D006278:Medicare / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000401:mortality* / Q000601:surgery*