Presentation Authors: Hanson Zhao, Colby P. Souders, Andrew Chen*, Catherine Bresee, D. Joseph Thum, Los Angeles, CA, Alex Hannemann, Vermillion, SD, Jennifer T. Anger, Los Angeles, CA, George D. Webster, Durham, NC
Introduction: Pelvic fracture associated urethral injuries (PFUIs) can cause significant patient morbidity. The management of these patients is complex and can result in lifelong consequences in the forms of stricture, incontinence, and erectile dysfunction. There is a large discrepancy in the prevalence and etiologies of PFUIs between different countries, which is related to differences motor vehicle regulations, seat belt laws, and traffic infrastructure. In the United States, statewide seat belt laws were passed from 1984-1995 and airbag requirements went into effect in 1998. We use a large contemporary population based cohort to assess the temporal trend in PFUIs after these regulations.
Methods: The National Inpatient Sample (NIS) is a weighted sample of inpatient hospital discharge data with ICD-9 procedure and diagnosis codes. Pelvic fractures were identified by any of the 808.xx ICD-9 diagnosis codes. PFUI was identified by the combination of an 808.xx diagnosis code with an ICD-9 procedure code for suprapubic tube placement (either code 57.17 or 57.18). SAS v9.2 software was used to analyze frequencies. All data were analyzed with trend weights provided by the NIS to account for changes in the study design over time using years 1998-2014.
Results: Average age was 38 years. 784 (11.5%) patients were female. 654 patients (9.6%) died while hospitalized. There was downward trend in the annual incidence of PFUI in the time frame studied. The incidence of PFUI significantly decreased from 1.7 +/- 0.2 cases per 100,000 hospital discharges in 1998 to 0.7 +/- 0.1 cases per 100,000 in 2011 (p=0.0067). The incidence appears to have stabilized from 2011 to 2014. In the time frame studied, National Highway Traffic Safety Administration surveys demonstrated that seat belt use increased from 58% to 87%.
Conclusions: While the true incidence of PFUI is likely underestimated in this study, we demonstrate a decreasing trend in the incidence of PFUI in the United States from 1998 to 2014. This occurred after mandatory seat belt and airbag motor vehicle regulations that were implanted in the 1990s. This decrease does, however, result in fewer opportunities to train reconstructive surgeons in complex posterior urethroplasty.