Presentation Authors: Matthew Clements*, C William Pike, Jacqueline Zillioux, David Rapp, Charlottesville, VA
Introduction: Published in May 2012, the Value of Urodynamic Evaluation (VALUE) study suggested that routine urodynamics (URD) are not beneficial for pre-operative evaluation of uncomplicated, stress-predominant incontinence (SUI). Accordingly, professional organizations have advocated against routine pre-operative URD (pre-URD) in "index" SUI patients. We assessed URD rates in patients undergoing slings through analysis of patient claims data with focus on use following the VALUE study.
Methods: We identified female patients in the Virginia All Payers Claims Database with diagnosis of SUI from May 2011-December 2016 using appropriate ICD codes. CPT codes were used to select the subset undergoing URD and/or slings. Pre-URD was defined as URD within six months of sling placement. Non-index patients were defined as those with concurrent diagnosis of overactive bladder, urge incontinence, or neurogenic bladder, and were excluded from analysis. We analyzed longitudinal rate of URD in patients undergoing sling placement and fitted an interventional ARIMA model with a step function after the time of the VALUE study publication. To evaluate changes in proportion of slings with pre-URD, we fitted a beta regression model using a logit link.
Results: A total of 44,347 patients with a SUI diagnosis were identified over the study period, with a mean of 7391 patients/year. Of index patients with a SUI diagnosis, 5,944 underwent sling procedures. The mean number of slings and URD per year was 1236 and 3488, respectively. A decrease in the annual number of slings, both with and without pre-UDS, was seen beginning in mid-2012 (Figure 1). In addition, interventional ARIMA models confirmed significant decreases in in number of slings with (p=0.02) and without (p < 0.001) pre-URD. The proportion of slings with pre-URD demonstrated a small decrease over the study years (68%, 2011; 58%, 2016), with an estimated decrease in pre-operative URD by 0.85%/month (p < 0.001).
Conclusions: Our study demonstrates a decrease in the number of slings both with and without pre-URD in uncomplicated patients following publication of the VALUE study in May 2012. Notably, there was a small but significant decrease in the proportion of slings with pre-URD among index patients. Further research is needed to examine trends of pre-URD and underlying influences.