Examining the role of frailty on treatment patterns and complications among older women undergoing procedure-based treatment for urinary incontinence

Background Aging beyond 65 years is associated with increased prevalence of urinary incontinence (UI), frailty, and increased complication rate with UI treatments. To investigate this relationship, we examined frailty as a predictor of procedure-based UI treatment patterns and urologic complications in Medicare-eligible women. Methods We identified women undergoing procedures for UI between 2011-2018 in the 5% limited Medicare data set. A Claims-based Frailty Index (CFI) using data from the 12-months prior to the index procedure defined frailty (CFI≥0.25). Urologic complications were assessed during the 12-months following the index procedure. We used unadjusted logistic regression models to calculate odds of having a specific type of UI procedure based on frailty status. Odds of post-procedure urologic complications were examined with logistic regression adjusted for age and race. Results We identified 21,783 women who underwent a procedure-based intervention for UI, of whom 3,826 (17.5%) were frail. Frail women with stress UI were 2.6 times more likely to receive periurethral bulking (95%CI 2.26-2.95), compared to non-frail. Conversely, frailty was associated with lower odds of receiving a Sling or Burch colposuspension. Among women with urgency UI or overactive bladder (OAB), compared to non-frail, frailty was associated with higher odds of both sacral neuromodulation (OR=1.21, 95%CI 1.11-1.33) and intravesical Botox (OR=1.16, 95%CI 1.06-1.28), but lower odds of receiving posterior tibial nerve stimulation. Frailty was associated with higher odds of post-procedure urologic complications (OR=1.64, 95%CI 1.47-1.81). Conclusions Frailty status may influence treatment choice for treatment of stress or urgency UI symptoms and increase the odds of post-procedural complications in older women.