Surgical Procedures for Stress Urinary Incontinence in 1999

        Drs. M. A.  Nihira, J. I. Schaffer

  University of Texas Southwestern

  Dallas, Texas

Objective:   To define the procedure performed, patient demographics, duration of stay, regional distribution, hospital charges and payor for surgical admissions for female stress urinary incontinence in 1999.
Methods:   The current epidemiological literature on surgery for stress urinary incontinence is based on projections from relatively small, selected samples of patients.  We queried the 1999 Solucient Projected Inpatient Database for the following procedures:  plication of the urethrovesical junction, suprapubic sling, retropubic urethral suspension and paraurethral suspension (ICD-9 procedure codes 59.3, 59.4, 59.5 and 59.6).  These projections are based upon over 12 million inpatient discharges from nearly 2,500 acute care American hospitals (approximately one-third of all US hospitals).  The specific data obtained from these facilities are statistically adjusted to represent all the nonfederal, general, short stay hospitals in the United States.  The projection factors were derived from two external sources, the National Hospital Discharge Survey (NHDS) and the Medicare Provider Analysis and Review File (MedPAR).
Results:   In 1999, there were a projected 83,010 urinary incontinence procedures.  Over 68% (56,803) of these procedures were performed on women less than 60 years of age; and specifically 53% (44,204) were performed on women between the ages of 40 and 59.  Of the procedures, over 73% (61,037) were retropubic urethral suspensions, 18% (14,981) were suprapubic slings, 5% (4,333) were plications of the urethrovesical junction and 3% (2,659) were paraurethral suspensions.  Overall, 82% of the patients were discharged in three days or less.  There were 12 projected deaths among those in which the SUI operation was the principal procedure.  Geographically, 41% were performed in the South, 14% in the Northeast, 21% in the North Central, and 24% in the West.  Almost 83% were performed in non-teaching hospitals.  Approximately 45% of admissions were to hospitals that had less than 200 beds.  The estimated total hospital charges were over 220 million dollars.  Sixty-seven percent of the admissions were primarily billed to commercial insurance, whereas 21% were billed primarily to Medicare.
Conclusions:   In 1999 there were over 83,000 procedures for female SUI.  The majority of the patients were between 40 to 59 years of age and the majority of admissions were billed to commercial insurance.  These operative admissions were associated with a relatively low mortality rate and most patients were discharged in three days or less.  The financial burden for the fixed-costs alone was over two hundred and twenty million dollars.
Key Words:   Urinary Incontinence, Surgery, Retropubic Urethropexy and Epidemiology