57: Age is just a number: in older patients, risk of postoperative admission, readmission and complications after sling procedures for stress incontinence is low

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To determine preoperative factors associated with postoperative hospital admission, readmissions, and complications amongst older patients undergoing sling procedures for stress urinary incontinence (SUI). This is a retrospective cohort study of surgical cases from The American College of Surgeons National Surgical Quality Improvement Program which is a nationally validated, multicenter database that contains preoperative, intraoperative and 30-day postoperative data from over 700 hospitals within the United States. We conducted a secondary analysis of surgical cases from 2012 through 2017. Patients were included if they were 65 years of age or greater. Patients undergoing concurrent procedures were excluded from this study. Comorbidities included obesity, diabetes, hypertension, bleeding disorder, steroid use, severe chronic obstructive pulmonary disease, congestive heart failure, ascites, ventilator dependence, dialysis, or acute renal failure. We identified 2692 eligible patients who underwent a sling procedure for SUI. Patients were more likely to be 65-74 years old (71.4%), white (68.4%) and non-Hispanic (66.3%). Comorbidities were common and included obesity (47.7%), hypertension (61.6%), and diabetes (18.1%). There were 454 (16.9%) post-operative admissions, and 48 (1.8%) readmissions. There was no association between the three age groups studied (ages 65-74, 75-84, 85 and over) with overnight admission or readmission. An ASA classification of III or IV was associated with an increased risk of overnight admission (risk ratio (RR) 1.4, 95% confidence interval (CI) 1.2-1.7) and readmission (RR 2.1, 95% CI 1.2-3.6). There appears to be an increased risk in admission and readmission in patients with multiple comorbidities, although our sample size is small. These findings are reflected in Table 1. There were 155 complications (5%), including 65 serious complications (2.4%) such as death, cardiac complication, stroke, renal failure, pulmonary embolism, ventilator use, reintubation, return to the operating room, readmission, or sepsis. There was an association between the number of comorbidities and the overall incidence of complications, serious complications, cardiac arrest and death (p<0.001 for all) as well as incidence of postoperative urinary tract infections (p<0.03). Overall, the risk of inpatient hospitalization and readmission is low in older patients, but patients with multiple comorbidities may be at higher risk. Serious complications are rare, although more likely to present in patients with multiple comorbidities. Older patients with few medical comorbidities who are undergoing a sling procedure for stress urinary incontinence may be reassured that they are not more likely to need postoperative hospitalization nor readmission.