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. 2009 May;200(5):521.e1-6.
doi: 10.1016/j.ajog.2009.01.007.

Trends in stress urinary incontinence inpatient procedures in the United States, 1979-2004

Sallie S Oliphant  1 , Li Wang, Clareann H Bunker, Jerry L Lowder
Affiliations

Trends in stress urinary incontinence inpatient procedures in the United States, 1979-2004

Sallie S Oliphant et al. Am J Obstet Gynecol. 2009 May.

Abstract

Objective: The purpose of this study was to describe national trends in surgery for female stress urinary incontinence (SUI).

Study design: We used data from the National Hospital Discharge Survey, a federal dataset sampling patient discharges from US inpatient hospitals. We analyzed patient and hospital demographics and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnostic and procedures codes for 1979-2004. Age-adjusted rates per 1000 women were calculated with 1990 US Census population data.

Results: The number of women who have undergone SUI surgery each year increased from 48,345 in 1979 to 103,467 in 2004. In women > or = 52 years old, the age-adjusted rate more than doubled from 0.64-1.60 procedures per 1000 women; in women < 52 years old, the age-adjusted rate fell from 0.57-0.47. Age-adjusted rates for retropubic urethral suspension (ICD-9-CM, 59.5) fell from 0.37 in 1979 to 0.14 in 2004. For suprapubic sling procedures (ICD-9-CM, 59.4), the age-adjusted rates rose from 0.02 in 1979 to a peak of 0.10 in 1997 and then fell to 0.03 in 2004. Age-adjusted rates for other repair of urinary stress incontinence (ICD-9-CM, 59.79) rose from 0.06 in 1979 to 0.64 in 2004.

Conclusion: The number of women who have undergone SUI surgery increased significantly from 1979-2004. Because the National Hospital Discharge Survey data do not include ambulatory procedures, accurate information on same-day surgeries is unavailable. Currently no ICD-9-CM procedure code exists specifically for midurethral sling procedures. Both missed sampling of same-day procedures and nonspecific or inaccurate coding may explain the surprising decline in suprapubic sling procedures and the rise in rates of other repair of SUI. A national ambulatory surgical database and a specific code for midurethral sling are needed to capture these important data.

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Figures

Figure 1
Figure 1
Estimated number of women undergoing incontinence procedures and age-adjusted rates of incontinence procedures per 1000 women from 1979 to 2004 in the United States
Figure 2
Figure 2
Age-adjusted rates of incontinence procedures per 1000 women from 1979 to 2004 in the United States, stratified by patient age
Figure 3
Figure 3
Age-adjusted rates of Retropubic urethral suspension (ICD-9-CM 59.5) per 1000 women from 1979 to 2004 in the United States
See this image and copyright information in PMC

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