Urological Surveillance and Medical Complications in the United States Adult Spina Bifida Population

Abstract

To evaluate urologic follow-up and prevalence of medical complications among adult patients in the United States with myelomeningocele (MMC) who are Medicare beneficiaries. We performed a retrospective study using a 5% Medicare sample from 2007 to 2010. We defined acceptable minimum follow-up criteria as patients receiving all of the following: serum creatinine, upper urinary tract imaging, and a urologist evaluation within a 2-year period. We queried associated diagnoses and relevant complications using International Classification of Diseases, Ninth Revision codes, graded based on clinical impact. A regression model identified factors associated with evaluation completeness as well as with increased prevalence of medical complications. We identified 825 patients with MMC, predominantly Caucasian (85.1%) and female (61.3%), with a mean age of 51.2 ± 17.2 years. Only 33.5% of the patients met the minimum acceptable follow-up criteria. Forty-four percent saw a urologist within the 2-year period. Most complications observed were mild, observed in 27.6% of patients. Moderate and severe complications were observed in 17.0% and 6.6% of patients, respectively. The most common complications were cystitis (16.4%), pressure ulcers (7.1%), chronic kidney disease (4.4%), and pyelonephritis (3.7%). Logistic regression indicated that younger age, male gender, and adequate follow-up were associated with increased prevalence of complications. Despite high prevalence of complications in patients with MMC, most are not receiving the minimum recommended follow-up. The 33.5% of patients who received adequate surveillance were diagnosed with more complications, likely secondary to improved disease ascertainment. Prospective studies are needed to look at follow-up strategies and how these can improve outcomes for patients with MMC.