Thromboembolic complications of sling surgery for stress urinary incontinence among female Medicare beneficiaries.
OBJECTIVE
To determine the rate of thromboembolic complications after sling surgery for stress urinary incontinence among female Medicare beneficiaries aged 65 and older.


METHODS
We analyzed the 1999-2001 Medicare public use files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women undergoing sling procedures from January 1, 1999 to July 31, 2000 were identified by the Physicians Current Procedural Terminology Coding System (4th edition) codes and tracked for 12 months. Diagnoses of postoperative thromboembolism were identified with International Classification of Diseases (9th revision) codes. Multivariate analysis was used to determine independent risk factors for developing a thromboembolic event.


RESULTS
A total of 1356 slings were performed on patients in the 5% sample of female Medicare beneficiaries during the 18-month index period. Concomitant prolapse surgery was performed in 467 (34.4%) cases. At 3 months after surgery, thromboembolic complications had occurred in 0.9% women undergoing a sling alone and in 2.2% women undergoing concomitant prolapse surgery (P = .05). Multivariate analysis revealed that concomitant prolapse surgery was associated with nearly 3 times the odds of thromboembolic complications (odds ratio 2.86, 95% confidence interval 1.10-7.45).


CONCLUSIONS
Our results show a low rate of thromboembolism after an isolated sling procedure. However, we found an increased rate of deep venous thrombosis and pulmonary embolism among women undergoing sling surgery with prolapse repair, which emphasizes the need for appropriate deep venous thrombosis prophylaxis in this patient group.
Department of Urology, David Geffen School of Medicine and School of Public Health, University of California, Los Angeles, California 90095-1738, USA. janger@mednet.ucla.edu
Jennifer T
JT
Anger
Aviva E
AE
Weinberg
John L
JL
Gore
Qin
Q
Wang
Chris L
CL
Pashos
Michael J
MJ
Leonardi
Larissa V
LV
Rodríguez
Mark S
MS
Litwin
D000368:Aged; D005260:Female; D006801:Humans; D006278:Medicare; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*; D014481:United States; D014550:Urinary Incontinence, Stress / Q000601:surgery*