Population based trends in procedures following sling surgery for urinary incontinence

Abstract

Introduction and hypothesis: To investigate practice patterns and variation associated with sling removal/revision and urethrolysis on a population level.

Methods: We used CPT 4 codes and the State Ambulatory Surgery Database (SASD) to identify all ambulatory procedures for sling removal/revision and urethrolysis from 2004 to 2009 in Florida. Next, we calculated adjusted rates for these procedures and measured regional variation in rates at the level of the Hospital Service Area (HSA).

Results: During this time period, rates of secondary procedures following slings more than doubled from 3.2 per 100,000 to 6.5 per 100,000 population (p<0.001). There was a large amount of regional variation, with rates of these procedures varying more than 5-fold across HSAs. Regions that placed more slings did not necessarily have higher rates of secondary procedures following sling placement.

Conclusions: The large amount of variability in rates of secondary procedures following slings signifies considerable uncertainty about the indications for these procedures. Further research is warranted to better explain potential sources for this variation in order to improve the quality of care surrounding midurethral sling placement and the recognition and treatment of its complications.