Concurrent Gynecologic Oncologic Surgery and Urethral Slings: An - - PowerPoint PPT Presentation

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Concurrent Gynecologic Oncologic Surgery and Urethral Slings: An Underused Modality

Melissa A. Markowitz, BA1, Claire S. Burton, MD2, Catherine Bresee, MS3 Colby P. Souders, MD4, Alex Hannemann, BA5, Jennifer T. Anger, MD MPH4 Karyn S. Eilber, MD4

1David Geffen School of Medicine, University of California, Los Angeles, CA 2Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA 3Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA 4Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 5University of South Dakota Sanford School of Medicine, Vermillion, SD

Disclosures

• None.

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Introduction

• Women with gynecologic malignancies have up to a 30% rate of

concomitant stress urinary incontinence (SUI)1.

• Additionally, women with malignancies and SUI report worse

quality of life (QOL) than those without SUI2.

• Recent reports have suggested that concurrent pelvic organ

prolapse or urinary incontinence surgery at the time of gynecologic oncology surgery is safe.

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1Bretschneider, C. E. et al (2016). Prevalence of pelvic floor disorders in women with suspected gynecological malignancy: a survey-based study. International urogynecology journal, 27(9). 2Egil Skjeldestad, F., & Hagen, B. (2008). Long-term consequences of gynecological cancer treatment on urinary incontinence: a population-based cross-sectional study. Acta obstetricia et

gynecologica Scandinavica, 87(4), 469-475.

Aims

• Evaluate complication rates, length of stay (LOS), and cost

between gynecologic oncology procedures with and without urethral sling placement for SUI using the National Inpatient Sample (NIS).

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Methods

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• National Inpatient Sample (NIS), 2010-2014
• 220,990 women underwent hysterectomy or
• ophorectomy for gynecologic malignancy
• 1,567 women underwent concurrent gynecologic
• ncologic surgery and urethral sling placement (0.71%)

Results

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Gyn Onc Surgery Alone Gyn Onc Surgery + SUI Procedure p-value (n=220,223) (n=1,567) Age (years) 60.6 +/- 0.09 63.4 +/- 0.7 < 0.001 Race 0.002 Caucasian 145,625 72.4% 1,107 78.5% African American 21,098 10.5% 45 3.2% Hispanic 19,088 9.5% 155 11.0% Not identified 15,428 7.7% 103 7.3% Total Complications

(cardiac, vascular, respiratory, digestive, urinary, shock, wound, VTE & bowel)

62,924 28.57% 334 21.32% 0.011 Complications per Person 157,299 71.43% 1,232 78.68% 0.002 1 47,231 21.45% 259 16.53% 2 12,300 5.59% 50 3.21% ≥3 3,393 1.54% 25 1.59% Deaths 1,111 0.50% 0% N/A

Results

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Gyn Onc Surgery Alone Gyn Onc Surgery + SUI Procedure p-value Length of stay (days) 4.35 +/- 0.04 3.10 +/- 0.20 < 0.001 Total charges ($) 56,062 +/- 864 53,992 +/- 3,114 0.484

Conclusion

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• Women undergoing concurrent procedures for a gynecologic

malignancy and SUI showed no increase in complications, LOS, or cost.

• Given the high prevalence and decreased QOL of concurrent

SUI and gynecologic malignancy, appropriate patients can benefit from concurrent treatment of SUI at the time of surgery for gynecologic malignancy.

Thank you

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