Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis: Developed by the AUGS Payment Reform Committee.

Autor:	Hall EF; From the Department of Obstetrics and Gynecology, Tufts University, Boston, MA., Biller DH; Division of Urogynecology, Department of OBGYN, Vanderbilt University Medical College, Nashville, TN., Buss JL; Institute for Informatics, Washington University School of Medicine, St Louis, MO., Ferzandi T; Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, Los Angeles, CA., Halder GE; Division of Urogynecology, Department of OBGYN, University of Texas Medical Branch, Galveston, TX., Muffly TM; Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, CO., Nickel KB; Division of Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, MO., Nihira M; KPC Healthcare, UC Riverside School of Medicine, Riverside, CA., Olsen MA; Division of Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, MO., Wallace SL; Division of Urogynecology, Subspecialty Care for Women's Health, Cleveland Clinic, Cleveland, OH., Lowder JL; Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO.
Jazyk:	angličtina
Zdroj:	Urogynecology (Philadelphia, Pa.) [Urogynecology (Phila)] 2023 Jun 01; Vol. 29 (6), pp. 536-544. Date of Electronic Publication: 2023 May 19.
DOI:	10.1097/SPV.0000000000001362
Abstrakt:	Objective: This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. Methods: This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. Results: Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). Conclusions: In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings. Competing Interests: E.F.H., D.H.B., J.L.B., T.F., G.E.H., T.M.M., K.B.N., and S.L.W. report no conflicts of interest. M.N. reports legal consultation to Ethicon. M.A.O. reports grant funding and consulting fees from Pfizer. J.L.L. serves as an expert witness and reports grant funding from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. (Copyright © 2023 American Urogynecologic Society. All rights reserved.)
Databáze:	MEDLINE
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