Surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) is commonly performed in older women, however, research studies are mainly reflective of younger and healthy individuals.  While older and frail older women are often excluded from clinical trials, they represent a large and growing percentage of the population considering surgical treatment for these conditions.  The purpose of this study is to build prognostic models that will be used to develop a risk assessment tool for older women undergoing surgery for SUI and POP, including the oldest and most frail individuals.

This IRB approved study evaluated all fee-for-service Medicare beneficiaries undergoing surgery for SUI and POP in the United States from 2014-2016 utilizing Medicare claims data from the Centers for Medicare and Medicaid Services (CMS).  Using relative risk regression modeling, 13 of the most highly predictive risk factors were identified from the Charlson Comorbidity Index (CCI) (representing 17 codes for comorbidities) and from the Claims Based Frailty Index (CFI) (representing 93 codes for durable medical equipment, comorbidities, and procedures).  These 13 predictors were combined with SUI and POP procedure type (categorized as 15 separate procedures for these conditions), subject age, and whether or not the individual lived in a nursing home, to calculate the number of events and c-statistics for 1-year mortality and 11 different surgical outcomes.

A total of 108,479 women ages 66 and older underwent surgery for SUI and POP during the study period.  The mean age was 73.6 +/- 5.7 years, mean CCI was 1.07 +/- 1.7, and mean CFI was 0.16 +/-0.05, indicative of prefrail classification on the CFI scale.  The most common procedure performed was anterior/posterior POP repair (17.8%), followed by sling procedures for SUI (11.0%), and anterior/posterior repair with apical POP repair (10.8%).  The frequencies of post-operative complications and c-statistics are shown in the Table below.  Overall, 19.2% of women experienced at least one post-operative complication and the models with the highest c-statistics were for cardiovascular complications (c-statistic=0.87), 1-year mortality (c-statistic=0.84), pulmonary complications (c-statistic=0.75), acute renal failure and other postoperative renal complications (c-statistic=0.73).

Models using clinically important and readily available preoperative characteristics were successfully created to predict the likelihood of numerous post-operative outcomes among adults >65 years of age undergoing surgery for SUI and POP.

Data from this study will be used to create a web-based risk calculator that will support physicians and older women to make informed, data-driven, pre-operative decisions regarding surgery for SUI and POP.