Presentation Authors: Garrett Smith*, Natasha Ginzburg, Syracuse, NY
Introduction: Urinary incontinence is a prevalent condition that is becoming recognized in more women regardless of the presence of traditional risk factors. Female Pelvic Medicine & Reconstructive Surgery (FPMRS) is a subspecialty of urologists and gynecologists with expertise in the management of pelvic floor disorders, including refractory incontinence. We hypothesized that patients hospitalized after incontinence procedures would have different characteristics based on the level of training of their surgeon. FPMRS surgeons may treat more complex patients in metropolitan areas, and this may be associated with higher costs and length of hospitalization.
Methods: New York State Statewide Planning and Research Cooperative System (SPARCS) inpatient de-identified datasets were queried for women who underwent genitourinary incontinence procedures from 2009 to 2016. Descriptive statistics using chi-square tests were performed to compare FPMRS-trained surgeons to non-FPMRS surgeons. Age, race, length-of-stay (LOS), hospital service area, and cost were assessed, as was All Patient Refined severity of illness (classified as major, moderate, mild), which calculates the impact of comorbid diseases on a patient's overall health.
Results: Patients undergoing incontinence procedures did not differ by age (p=0.545), however they did differ by race (p=0.001), with FPMRS surgeons operating on more black women (10.3%) and fewer white women (67.0%) compared to non-fellowship trained surgeons (8.2%,75.0%). LOS did not differ between groups (p=0.276). Severity of overall patient illness did not differ significantly based on training (p=0.193), however 31.0% of moderately complex patients were operated on by FPMRS-trained providers compared to 27.6% in the non-FPMRS group. Fellowship-trained surgeons concentrated near large cities, with 68.3% of all incontinence procedures in Manhattan performed by FPMRS-trained surgeons, versus 39.6% in the Finger Lakes region or 4.5% in Western NY, for instance. Finally, cost differed significantly between groups (p=0.000), with 75.1% of non-FPMRS surgeons having total costs under $7,500 versus 53.7% under such cost in the FPMRS-trained group. Insurance payer did not differ by provider type (p=0.157).
Conclusions: There was a geographical concentration of practice for FPMRS-trained surgeons in metropolitan areas, presumably at academic centers. They treated a more diverse demographic of patients, but insurance type did not differ. Cost was expectedly higher, however this was not influenced by age or reported severity of illness, nor was it explained by longer hospital stays. More work is needed to determine the clinical and economic impact of these data, particularly in regard to patient outcomes and the need for reoperation. Limitations were innate to the database used, as broad diagnosis and procedure codes may not capture differences in the type or complexity of operation (i.e. fascial vs mesh sling).