(312) Area Deprivation Index in Men Undergoing AUS Placement– Community Resource Limitations Do Not Correlate with Poorer Device or Satisfaction Outcomes
Authors: Cabo J , Johnsen N , Zwaschka A , Koch G , Bhalla R , Gambrah H 
Published: May 2023

Abstract

Introduction
Outcomes following artificial urinary sphincter (AUS) placement have been associated with non-urologic health metrics including hemoglobin A1c and BMI, as well as with health literacy and frailty. Concerns about these patient factors may lead urologic prosthetic surgeons to alter their recommendations for stress urinary incontinence treatment to avoid poor patient outcomes. The Area Deprivation Index (ADI) is a ranking system to measure socioeconomic disadvantage between neighborhoods and correlates with rates of chronic medical conditions such as diabetes and cardiovascular disease, as well as healthcare service utilization and death. This ranking system includes a composite score of patient income, education level, employment status and housing quality. Evaluating socioeconomic disadvantage may help implanters tailor their patient counseling and improve patient pre- and postoperative education.

Objective
We sought to characterize variability in functional, subjective, and objective outcomes following AUS placement according to ADI.

Methods
Patients were identified by CPT codes for AUS insertion, removal/replacement, and revision from 2014 to 2022 at our institution. National percentile ADI was obtained using the Neighborhood Atlas® (Madison, WI) based on patient home address. Higher ADI scores indicate greater socioeconomic disadvantage. Associations of ADI with post-AUS satisfaction, device survival, and complications including (I) any Clavien-Dindo complication and (II) complications requiring surgical intervention. Patient satisfaction was assessed on a 1-5 Likert scale based on telephone interviews.

Results
284 patients met inclusion criteria with 232 having data available regarding complications. Median ADI scores in our cohort was 59 (41-75), and we divided the cohort according to high (&gt;58) and low socioeconomic deprivation groups based on this cutoff. Of these, 53 (22.8%) experienced any complication following AUS procedure, over a median of 6.3 months follow up. Device survival at last follow up was similar between low (88.8%) and high ADI groups (92%, P=0.41). Patients with low and high ADI scores had similar overall complication rates (21.6% vs. 24.4%; P=0.64) of any Clavien-Dindo score. Device survival was high at last follow up regardless of ADI score (88.8% vs. 92.0%; P=0.41) with total follow up also being similar between groups (5.64 mo vs. 8.01 mo; P=0.23). Time from prostatectomy to AUS implantation was also similar between high and low ADI groups (4.23 years vs. 4.17 years, P=0.70) Finally, patient satisfaction was very high in both the low and high ADI groups (5 vs. 5; P=0.41).

Conclusions
ADI was not associated with time to sphincter implantation, postoperative complications, patient satisfaction or device survival. Despite ADI capturing several factors that potentially impact a patient’s ability to optimally access medical care-including income, education and housing quality, we found no evidence that socioeconomic disadvantage by ADI scores was predictive of poorer outcomes, satisfaction, or suboptimal follow up.

Disclosure
No