50 Reoperation rates of stress incontinence surgery in rural versus urban hospitals

Abstract

To determine the impact of a rural versus urban hospital location on the risk of having a second surgery for stress urinary incontinence. Using the Cerner Health Facts nationwide electronic medical record database, we identified patients who underwent surgeries for stress incontinence between 01/01/2010 and 11/30/2018. Patients were divided into two cohorts: those who had a single operation and those who received a repeat operation, defined as any stress incontinence surgery or revision after initial incontinence surgery. Logistic regression was performed to determine whether urban versus rural hospital location impacted reoperation rates. We adjusted for confounders including sociodemographic variables with P<0.1 on univariable analysis. Of the 25,085 women who underwent stress incontinence procedures, 669 (2.7%) underwent a second surgery. The median age was 54 (IQR=45-66). 85.5% identified as white and 4.5% identified as black. 7,720 (30.8%) were obese and 2,660 (10.6%) had diabetes. There was a higher rate of repeat stress incontinence procedures in patients who were obese (3.0% vs 2.5%, P=0.017). In patients who underwent concomitant apical prolapse procedures with their index surgery, there were fewer repeat surgeries (2.2% vs 2.8%, P=0.012). On univariable analysis, we did not detect a difference between women who lived in rural vs. urban areas (OR=1.16, 95%CI=0.94-1.43). After adjusting for confounders, we still did not see a significant difference between rural hospital location and risk of repeat surgery (OR=0.99, 95%CI=0.99-1.00). Obesity increased the risk of having a repeat surgery (OR=1.21) while patients who had concomitant prolapse procedures with their index surgery had reduced risk of having a repeat surgery (OR=0.79). A summary of the full regression is displayed in Table 1. We did not detect a difference in rural versus urban hospital location on the risk of reoperation for women undergoing stress incontinence surgery. Patients who were obese were more likely to have a repeat surgery while patients with concomitant incontinence were less likely to undergo reoperation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)