Frail women at risk of complications, repeat procedure after sling surgery

Frailty is associated with a higher relative risk of 30-day complications, 1-year mortality, and repeat procedures for persistent incontinence or obstructed voiding at 1 year after sling surgery in older adults, suggests a recent study.

The authors examined data for all Medicare beneficiaries aged ≥65 years who underwent sling surgery with or without concomitant prolapse repair from 2014 to 2016. They stratified beneficiaries using the Claims-Based Frailty Index (CFI) into four categories: not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), mildly frail (0.25 ≤CFI <0.35), and moderately to severely frail (CFI ≥0.35).

Of the 54,112 women who underwent sling surgery during the study period, 5.2 percent were mildly to moderately to severely frail. Beneficiaries with moderate to severe frailty showed an increased adjusted relative risk (aRR) of 30-day complications (56.6 percent; aRR, 2.6, 95 percent confidence interval [CI], 2.2‒2.9) and 1-year mortality (10.5 percent; aRR, 6.7, 95 percent CI, 4.0‒11.2) compared to those who were not frail.

In addition, the rates of repeat procedures were higher in the mildly to severely frail group (6.6 percent; aRR, 1.4, 95 percent CI, 1.2‒1.6) relative to the not frail group.

“While there were fewer sling surgeries performed in frail women, the observed increase in complication rates was significant,” the authors said. “Frailty should be strongly considered before pursuing sling surgery in older women.”

Sling surgery is considered the gold standard in the treatment of women with stress urinary incontinence.