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Medline ® Abstract for Reference 1

of 'Surgical management of stress urinary incontinence in women: Bladder neck fascial sling procedures'

Trends in stress urinary incontinence inpatient procedures in the United States, 1979-2004.
Oliphant SS, Wang L, Bunker CH, Lowder JL
Am J Obstet Gynecol. 2009 May;200(5):521.e1-6.
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 1979to 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.
Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.