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The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study
INTRODUCTION AND HYPOTHESIS: The efficacy of mid-urethral sling (MUS) surgery in older women and women with a significant disease burden is limited. We aimed to determine the influence of chronological age and physical status (assessed by the American Society of Anesthesiologists Physical Status, AS...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038952/ https://www.ncbi.nlm.nih.gov/pubmed/36181548 http://dx.doi.org/10.1007/s00192-022-05364-6 |
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author | Gyhagen, Julia Åkervall, Sigvard Larsudd-Kåverud, Jennie Molin, Mattias Milsom, Ian Wagg, Adrian Gyhagen, Maria |
author_facet | Gyhagen, Julia Åkervall, Sigvard Larsudd-Kåverud, Jennie Molin, Mattias Milsom, Ian Wagg, Adrian Gyhagen, Maria |
author_sort | Gyhagen, Julia |
collection | PubMed |
description | INTRODUCTION AND HYPOTHESIS: The efficacy of mid-urethral sling (MUS) surgery in older women and women with a significant disease burden is limited. We aimed to determine the influence of chronological age and physical status (assessed by the American Society of Anesthesiologists Physical Status, ASA) classification on outcomes. METHODS: Cure rate, change in frequency of lower urinary tract symptoms, satisfaction, impact, and adverse events after MUS surgery were assessed in 5200 women aged 55–94 years with MUS surgery (2010–2017). Data were analysed by multivariate logistic regression and Mantel-Haenszel chi-square statistics. RESULTS: The cure rate was 64.2% (95% CI, 60.0–68.4) in the ≥ 75-year cohort compared to 88.5% (95% CI, 87.1–89.8) in the 55–64-year cohort (trend p < 0.0001). The estimated probability of cure, improvement, and satisfaction with the procedure decreased by aOR(10yr) = 0.51 for cure to aOR(10yr) = 0.59 for satisfaction (all p < 0.0001). Women with a significant health burden (ASA class 3–4) had lower cure rates and satisfaction than those without (65.5% vs. 83.7%, p < 0.0001 and 65.7% vs. 80.6%, p < 0.0001). Older age was more likely to be associated with de novo urgency (p = 0.0022) and nocturia ≥ 2 (p < 0.0001). Adverse events, readmission, and 30-day mortality rates were low. Women, irrespective of age, were equally satisfied if they experienced a decrease of at least one step in leakage frequency. CONCLUSIONS: Even if MUS surgery in older women and those with ASA class 3–4 was associated with a lower cure rate and less satisfactory outcome, a majority were satisfied provided they experienced a reduction of incontinence episodes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00192-022-05364-6. |
format | Online Article Text |
id | pubmed-10038952 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-100389522023-03-26 The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study Gyhagen, Julia Åkervall, Sigvard Larsudd-Kåverud, Jennie Molin, Mattias Milsom, Ian Wagg, Adrian Gyhagen, Maria Int Urogynecol J Original Article INTRODUCTION AND HYPOTHESIS: The efficacy of mid-urethral sling (MUS) surgery in older women and women with a significant disease burden is limited. We aimed to determine the influence of chronological age and physical status (assessed by the American Society of Anesthesiologists Physical Status, ASA) classification on outcomes. METHODS: Cure rate, change in frequency of lower urinary tract symptoms, satisfaction, impact, and adverse events after MUS surgery were assessed in 5200 women aged 55–94 years with MUS surgery (2010–2017). Data were analysed by multivariate logistic regression and Mantel-Haenszel chi-square statistics. RESULTS: The cure rate was 64.2% (95% CI, 60.0–68.4) in the ≥ 75-year cohort compared to 88.5% (95% CI, 87.1–89.8) in the 55–64-year cohort (trend p < 0.0001). The estimated probability of cure, improvement, and satisfaction with the procedure decreased by aOR(10yr) = 0.51 for cure to aOR(10yr) = 0.59 for satisfaction (all p < 0.0001). Women with a significant health burden (ASA class 3–4) had lower cure rates and satisfaction than those without (65.5% vs. 83.7%, p < 0.0001 and 65.7% vs. 80.6%, p < 0.0001). Older age was more likely to be associated with de novo urgency (p = 0.0022) and nocturia ≥ 2 (p < 0.0001). Adverse events, readmission, and 30-day mortality rates were low. Women, irrespective of age, were equally satisfied if they experienced a decrease of at least one step in leakage frequency. CONCLUSIONS: Even if MUS surgery in older women and those with ASA class 3–4 was associated with a lower cure rate and less satisfactory outcome, a majority were satisfied provided they experienced a reduction of incontinence episodes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00192-022-05364-6. Springer International Publishing 2022-10-01 2023 /pmc/articles/PMC10038952/ /pubmed/36181548 http://dx.doi.org/10.1007/s00192-022-05364-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Gyhagen, Julia Åkervall, Sigvard Larsudd-Kåverud, Jennie Molin, Mattias Milsom, Ian Wagg, Adrian Gyhagen, Maria The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
title | The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
title_full | The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
title_fullStr | The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
title_full_unstemmed | The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
title_short | The influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
title_sort | influence of age and health status for outcomes after mid-urethral sling surgery—a nationwide register study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038952/ https://www.ncbi.nlm.nih.gov/pubmed/36181548 http://dx.doi.org/10.1007/s00192-022-05364-6 |
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