Outcome by case volume and hospital status

StudyStudy type and ELAim of studyNumber of participantsParticipant characteristicsOutcomesResultsAdditional comments
Hutchings 1998126
Associated reference Black 1997125
Only data relevant to competence question reproduced in this table
Cohort
EL = 2+
To identify risk factors consistently predictive of a successful outcome up to 1 year after surgery for stress UI (outcomes explored were complications, symptom severity index, symptom impact index, and activities of daily living)
Health-service factors investigated: pre-op urodynamics, surgical procedure, concomitant procedure, surgeon specialty, (gynae or urology), grade (consultant or not), volume of cases per annum, hospital teaching status
232*
82% responded to Questionnaires
38 gynaecologists and 11 urologists from the North Thames region who carry out surgery for stress UI in NHS hospitals.** Completed questionnaires on pts prior tx, presentation, the procedure, urodynamic investigations, specialty and grade of surgeon, work volume, and hospital teaching status.
F undergoing stress UI surgery by 1 of these surgeons between Jan 93 and Jun 94 (excluded if unable to read or understand English). Completed questionnaires on sociodemographic factors, age, general health, UI history severity and impact, and co-existent conditions. Mean age 52 years. 50% underwent colposuspension, 29% anterior repair, 12% needle suspension, 4% missing info, 4% other
Odds for a better outcome of surgery (univariate analysis) according to high volume (20–42 cases per year vs 1–19 cases per year)No complications (20–42 cases vs 1–19 per year):
OR 0.87 (95% CI 0.50 to 1.50)
Reduction in SSI:
OR 1.51 (95% CI 0.83 to 2.73)
Reduction in SII:
OR 1.77 (0.96, 3.27)
Improvement in ADL:
1.07 (0.60, 1.92)
Funding: MRC Health Services Research and Public Health Board.
Multivariate analysis using logistic regression.
*for whom both patients and surgeons completed questionnaires (of 631 F invited to participate).
Of 64 (47%) who accepted request to participate in study; the 49 were selected because representative of surgeon’s work volume, specialty, teaching status, and geographic location of hospital.
18% hospitals were teaching, 82% non-teaching.
**sig. higher risk of complications reported by surgeon speciality on univariate and multivariate analysis, but when wound problems excluded from analysis (because more gynae undertook anterior repair where there is no wound), this significance did not persist. When analysis restricted to colposuspension gynae associated with fewer complications than urologists (data not shown in paper). Also sig. greater improvement in SII for gynae vs urologists.
Odds for a better outcome for surgery according to hospital status (non-teaching vs teaching)Univariate analysis: (non-teaching vs teaching)
OR 2.32 (95% CI 1.01 to 5.29)
Multivariate analysis
No longer statistically significant (data not given in paper)

From: Evidence tables for included studies

Cover of Urinary Incontinence
Urinary Incontinence: The Management of Urinary Incontinence in Women.
NICE Clinical Guidelines, No. 40.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2006 Oct.
Copyright © 2006, National Collaborating Centre for Women’s and Children’s Health.

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