Comparing Trends in Urethral Sling Procedures Performed by Urologists and Gynecologists: Is There Anything Significantly Different?

Abstract

INTRODUCTION: Sling procedures, the most common surgical treatment for stress urinary incontinence, are performed by both urologists and gynecologists. Our study aims to examine differences in operative times and surgical metrics based on surgeon subspecialty training. METHODS: This study is a retrospective review of the 2005 to 2015 National Surgical Quality Improvement Program database. Patients who underwent a sling operation as their primary procedure were identified. Chi-square analysis and independent t-tests were used for statistical comparisons. RESULTS: A total of 21,040 patients were included. Urologists completed 38.8% of the cases, and gynecologists completed 61.2%. Urologists had shorter operative times (45.93 vs 54.21 minutes; p < 0.001; 95% CI –9.66 to –6.91), were more likely to complete the procedure outpatient (85.4% vs 83.5%; p < 0.001), and performed fewer concomitant procedures (16.1% vs 32.3%; p < 0.001) such as pelvic prolapse repairs. Length of hospital stay was similar between specialties (0.40 vs 0.46 days; p = 0.078). Patients under 60 years saw gynecologists more frequently, while those 61 to 80 years saw urologists more often (p < 0.001). Urological patients had increased likelihood of having comorbidities, including obesity, diabetes, hypertension, smoking history, dyspnea, decreased functional status, chronic obstructive pulmonary disease, and chronic steroid use (p < 0.001; Table). Urologists were less likely to have a resident or fellow present (37.3% vs 42.8%; p < 0.001). CONCLUSION: Urologists were associated with shorter operative times for midurethral slings. They were more likely to operate outpatient, while gynecologists were more likely to perform concomitant procedures and have a trainee present. Urologists operated on older patients who tended to have more comorbidities and had similar lengths of hospital stay. Table. - Comparison of Patient Comorbidities Variable Urology (%) Gynecology (%) p Value Obesity 50.6 47.5 <0.001 Diabetes 12.3 9.5 <0.001 Hypertension 38.9 33.0 <0.001 Current Smoker 15.9 13.0 <0.001 Dyspnea 6.1 4.2 <0.001 Decreased functional status 0.9 0.4 <0.001 COPD 3.8 2.3 <0.001 Chronic steroid use 2.1 1.4 <0.001