Procedures for urinary incontinence in the United States, 1979-1997

Objective: The objective of our study was to describe the national rates of surgery for urinary incontinence in women. Study Design: We used the National Hospital Discharge Survey, a federal database that samples inpatient hospitals in the United States. Data from 1979 to 1997 were analyzed for diagnoses and procedures coded by using the International Classification of Diseases, 9th revision, Clinical Modification, classification system. Age-adjusted rates were calculated by using the 1990 census population and compared for change over time with the score test for linear trend. Results: The number of women undergoing inpatient surgery for urinary incontinence has varied from 33,000 in 1979 to 85,000 in 1993. The rate of surgeries for incontinence has almost doubled, from 0.32 procedures per 1000 women per year in 1979 to 0.60 procedures per 1000 women per year in 1997 (P =.02). The number of suprapubic slings performed increased over time. Approximately 2100 slings were performed per year until 1996, when 7348 were performed, followed by 10,192 in 1997 (rate increase from 12 to 75.2 per 1,000,000 women per year, P =.03). Women undergoing incontinence procedures were 79% white, 3% African American, and the remaining 18% other (including unknown). Thirty-seven percent of cases were performed in the South, 25% in the Midwest and West, and 12% in the Northeast. From 1979 to 1997, the mean age of women at the time of surgery increased from 50.5 ± 12.1 years to 56.6 ± 13.3 years; mean length of hospital stay decreased from 9.9 ± 4.5 days to 2.7 ± 1.4 days (P