Frailty is associated with an increased risk of complications and need for repeat procedures after sling surgery in older adults
Open accessAbstract
PURPOSE: Sling surgery is the gold standard treatment for stress urinary incontinence in women. While data support the use of sling surgery in younger and middle-aged women, outcomes in older, frail women are largely unknown. MATERIALS AND METHODS: Data were examined for all Medicare beneficiaries ≥65 years old who underwent sling surgery with or without concomitant prolapse repair from 2014 to 2016. Beneficiaries were stratified using the Claims-Based Frailty Index (CFI) into 4 categories: not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), mildly frail (0.25 ≤CFI <0.35) and moderately to severely frail (CFI ≥0.35). Outcomes included rates and relative risk of 30-day complications, 1-year mortality and repeat procedures for persistent incontinence or obstructed voiding at 1 year. RESULTS: A total of 54,112 women underwent sling surgery during the study period, 5.2% of whom were mildly to moderately to severely frail. Compared to the not frail group, moderately to severely frail beneficiaries demonstrated an increased adjusted relative risk (aRR) of 30-day complications (56.5%; aRR 2.5, 95% CI: 2.2-2.9) and 1-year mortality (10.5%; aRR 6.7, 95% CI: 4.0-11.2). Additionally, there were higher rates of repeat procedures in mildly to severely frail beneficiaries (6.6%; aRR 1.4, 95% CI: 1.2-1.6) compared to beneficiaries who were not frail. CONCLUSIONS: As frailty increased, there was an increased relative risk of 30-day complications, 1-year mortality and need for repeat procedures for persistent incontinence or obstructed voiding at 1 year. While there were fewer sling surgeries in performed frail women, the observed increase in complication rates was significant. Frailty should be strongly considered before pursuing sling surgery in older women.
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The study population had a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.
“The current study population had both a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.”
Many studies addressing perioperative outcomes and frailty, including in gynecologic surgery, are retrospective in nature or database driven.
“Many studies--including those looking at gynecologic surgery--addressing perioperative outcomes and frailty are retrospective in nature or database driven leaving opportunity for further understanding the impact of frailty on gynecologic surgery outcomes in prospective surgical trials.7–16”
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- Authors
- Van Kuiken, M. E., Zhao, S., Covinsky, K., Boscardin, J., Finlayson, E., & Suskind, A. M.
- Affiliations
- Department of Urology, University of California, San Francisco, California
- University of California, San Francisco (US)
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California
- Venue
- Journal of Urology
- Published
- 2022-06
- Volume
- 207
- Issue
- 6
- Pages
- 1276-1284
- ISSN
- 0022-5347 (ISSN-L)
- 1527-3792
- PMC
- PMC9086120
- OpenAlex
- W4205153914
- Cited by
- 19
- References
- 22
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 3 · 2022: 2
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG058616)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Keywords
- frailty, sling surgery, stress urinary incontinence, older women, postoperative complications, repeat procedures, mortality, pelvic organ prolapse surgery, claims-based frailty index, Medicare beneficiaries
- MeSH terms
- Frailty, Aged, Female, Medicare, Humans, Male, Middle Aged, United States, Urinary Incontinence, Urinary Incontinence, Stress, Suburethral Slings
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