Sling Reoperation Rates in the AUA Quality (AQUA) Registry
The midurethral synthetic sling has been considered the gold standard in the surgical management of stress urinary incontinence, despite controversies surrounding transvaginal mesh. Early (<1 year) failure rates reported range from less than 4% in clinical series to over 10% among older Medicare beneficiaries. We used the AUA Quality (AQUA) registry, a national Qualified Clinical Data Registry (QCDR) designed to measure, report, and improve healthcare quality and patient outcomes, to study real-world reoperation rates after surgery for stress urinary incontinence, provider volume and types of anti-incontinence procedures performed.</p>
The AQUA Registry provides physicians with essential infrastructure and information they need to improve clinical practice and patient outcomes. As of November 2017, the AQUA Registry covers over 400 practices in 48 US States/territories in private practices, large health systems and academic centers. We abstracted 2014-2016 AQUA registry data from the first 95 urology practices to join to determine re-operation rates after surgery for stress urinary incontinence within one year of initial surgery. The relationships between provider volume and re-operation rate were measured using descriptive statistics and Pearson's correlation.
There were 8,571 incontinence procedures performed by 61 AQUA practices in 2014-2016. Overall reoperation rate by CPT code was 4.1%. Most first operations (95.4%) were slings, with many fewer bladder neck suspensions (MMK/Burch/Peyrera). Repeat procedures were usually the same procedure type performed a second time, even in the case of bladder neck suspensions. Among those undergoing a sling for the first procedure, 0.22% underwent a urethrolysis, 1.2% underwent a sling revision or takedown, and 3.4% underwent a repeat sling operation. There was no correlation between provider volume and reoperation rates (r=0.0058, p=0.96). There was a wide range of reoperation rates between practices (0-77%).
The sling, even after the mesh controversy with its negative press, dominates as the most common anti-incontinence procedure. Overall, sling failure rates, revisions, and takedowns were acceptably low across various practice settings. These low reoperation rates indicate that both low and high-volume providers can attain good outcomes with the sling.
Funding: American Urological Association