Wu Jennifer M, Dieter Alexis A, Pate Virginia, Jonsson Funk Michele
Department of Obstetrics and Gynecology, the Center for Women's Health Research, and the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Obstet Gynecol. 2017 Jun;129(6):1124-1130. doi: 10.1097/AOG.0000000000002051.
To assess the 5-year risk and timing of repeat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures.
We conducted a retrospective cohort study using a nationwide database, the 2007-2014 MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases (Truven Health Analytics), which contain deidentified health care claims data from approximately 150 employer-based insurance plans across the United States. We included women aged 18-84 years and used Current Procedural Terminology codes to identify surgeries for SUI and POP. We identified index procedures for SUI or POP after at least 3 years of continuous enrollment without a prior procedure. We defined three groups of women based on the index procedure: 1) SUI surgery only; 2) POP surgery only; and 3) Both SUI+POP surgery. We assessed the occurrence of a subsequent SUI or POP procedure over time for women younger than 65 years and 65 years or older with a median follow-up time of 2 years (interquartile range 1-4).
We identified a total of 138,003 index procedures: SUI only n=48,196, POP only n=49,120, and both SUI+POP n=40,687. The overall cumulative incidence of a subsequent SUI or POP surgery within 5 years after any index procedure was 7.8% (95% confidence interval [CI] 7.6-8.1) for women younger than 65 years and 9.9% (95% CI 9.4-10.4) for women 65 years or older. The cumulative incidence was lower if the initial surgery was SUI only and higher if an initial POP procedure was performed, whether POP only or SUI+POP.
The 5-year risk of undergoing a repeat SUI or POP surgery was less than 10% with higher risks for women 65 years or older and for those who underwent an initial POP surgery.
评估压力性尿失禁（SUI）和盆腔器官脱垂（POP）再次手术的5年风险及时间。
我们利用全国性数据库——2007 - 2014年市场扫描商业索赔与病历数据库以及医疗保险补充数据库（Truven Health Analytics）进行了一项回顾性队列研究，该数据库包含来自美国约150个基于雇主的保险计划的匿名医疗保健索赔数据。我们纳入了18 - 84岁的女性，并使用当前程序编码术语来识别SUI和POP手术。我们确定了在连续参保至少3年且无既往手术史后进行的SUI或POP索引手术。我们根据索引手术将女性分为三组：1）仅行SUI手术；2）仅行POP手术；3）SUI + POP联合手术。我们评估了年龄小于65岁和65岁及以上女性后续SUI或POP手术随时间的发生情况，中位随访时间为2年（四分位间距1 - 4）。
我们共确定了138,003例索引手术：仅SUI手术48,196例，仅POP手术49,120例，SUI + POP联合手术40,687例。任何索引手术后5年内，年龄小于65岁女性后续SUI或POP手术的总体累积发生率为7.8%（95%置信区间[CI] 7.6 - 8.1），65岁及以上女性为9.9%（95% CI 9.4 - 10.4）。如果初始手术仅为SUI，累积发生率较低；如果进行了初始POP手术，无论是仅行POP手术还是SUI + POP联合手术，累积发生率都较高。
再次进行SUI或POP手术的5年风险小于10%，65岁及以上女性以及接受初始POP手术的女性风险更高。
