Examining the role of frailty on treatment patterns and complications among older women undergoing procedure-based treatment for urinary incontinence.

BACKGROUND: Aging beyond 65 years is associated with increased prevalence of urinary incontinence (UI), frailty, and increased complication rate with UI treatments. To investigate this relationship, we examined frailty as a predictor of procedure-based UI treatment patterns and urologic complications in Medicare-eligible women.

METHODS: We identified women undergoing procedures for UI between 2011-2018 in the 5% limited Medicare data set. A Claims-based Frailty Index (CFI) using data from the 12-months prior to the index procedure defined frailty (CFI≥0.25). Urologic complications were assessed during the 12-months following the index procedure. We used unadjusted logistic regression models to calculate odds of having a specific type of UI procedure based on frailty status. Odds of post-procedure urologic complications were examined with logistic regression adjusted for age and race.

RESULTS: We identified 21,783 women who underwent a procedure-based intervention for UI, of whom 3,826 (17.5%) were frail. Frail women with stress UI were 2.6 times more likely to receive periurethral bulking (95%CI 2.26-2.95), compared to non-frail. Conversely, frailty was associated with lower odds of receiving a Sling or Burch colposuspension. Among women with urgency UI or overactive bladder (OAB), compared to non-frail, frailty was associated with higher odds of both sacral neuromodulation (OR=1.21, 95%CI 1.11-1.33) and intravesical Botox (OR=1.16, 95%CI 1.06-1.28), but lower odds of receiving posterior tibial nerve stimulation. Frailty was associated with higher odds of post-procedure urologic complications (OR=1.64, 95%CI 1.47-1.81).

CONCLUSIONS: Frailty status may influence treatment choice for treatment of stress or urgency UI symptoms and increase the odds of post-procedural complications in older women.