Long-term outcomes after stress urinary incontinence surgery.
OBJECTIVE
To compare the long-term risk of repeat stress urinary incontinence (SUI) surgery after different types of initial SUI surgery and to identify predictors of time to repeat SUI surgery in a large, population-based cohort.


METHODS
We used de-identified, adjudicated health care claims data from approximately 100 employer-based plans across the United States from 2000 to 2009. We identified the index SUI surgery in women aged 18 to 64 years. Kaplan-Meier survival curves were used to estimate cumulative incidence of repeat surgery through 9 years. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for factors associated with recurrent SUI surgery.


RESULTS
Over 10 years, we identified 155,458 eligible women who underwent one or more SUI surgeries, with a total of 294,855 person-years of follow-up. Of these index surgeries, 127,848 (82.2%) were slings. The 9-year cumulative incidence of repeat surgery after any SUI surgery was 14.5% (95% CI 13.4-15.5). As expected, bulking agents had the highest cumulative incidence of repeat surgery (61.2%, 95% CI 56.3-66.0) followed by needle suspension (22.2%, 95% CI 16.5-27.9); the lowest 9-year incidences were for Burch (10.8%, 95% CI 9.3-12.3) and sling (13.0%, 95% CI 11.7-14.3). In a Cox proportional hazards model that adjusted for age, year of index surgery, and region of the United States, the rate of repeat surgery was 28% higher for slings compared with Burch (adjusted HR 1.28, 95% CI 1.19-1.37).


CONCLUSIONS
In this population-based analysis of women aged 18 to 64 years, Burch procedures had the lowest 9-year cumulative incidence of repeat SUI surgery.
Department of Epidemiology, Gillings School of Global Public Health, and the Center for Women's Health Research, University of North Carolina at Chapel Hill, Chapel Hill, and the Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
Michele
M
Jonsson Funk
Nazema Y
NY
Siddiqui
Amie
A
Kawasaki
Jennifer M
JM
Wu
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D053825:Suburethral Slings / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult