A time-frame comparison study of surgical volume shifts on female primary stress urinary incontinence surgery.

Autor: Hsieh WL; Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan., Huang CC; Department of Healthcare Administration, College of Medicine, I-Shou University, Kaohsiung, Taiwan., Chou EC; Department of Urology, China Medical University Hospital, Taichung, Taiwan.; School of Medicine, China Medical University, Taichung, Taiwan., Lo TS; Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.; School of Medicine, Chang Gung University, Taoyuan, Taiwan., Long CY; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.; Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan., Wu MP; Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan. mpwu@mail.chimei.org.tw.; School of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan. mpwu@mail.chimei.org.tw.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2023 Jul; Vol. 34 (7), pp. 1453-1463. Date of Electronic Publication: 2022 Oct 18.
DOI: 10.1007/s00192-022-05377-1
Abstrakt: Introduction and Hypothesis: The objective was to investigate the surgical volume shifts for primary female stress urinary incontinence (SUI) over a 20-year period (1999-2018) in Taiwan.
Methods: This was a retrospective cohort study based on Taiwan's National Health Insurance Research Database. We divided the time-frame into four periods: first period (1999-2003), second period (2004-2008), third period (2009-2013), and fourth period (2014-2018). The variables included major surgical types for SUI (retropubic urethropexy, pubovaginal sling, midurethral sling, etc.), surgeon gender, specialty, surgical volume (high ≥30, median 5-29, low <5), and hospital accreditation level. Reoperation rates within 1 year were analyzed as an outcome measurement.
Results: A total of 51,018 patients were identified. Major surgical types increased significantly during the first three periods and slightly decreased during the fourth period. The proportion of surgical volume shifted from high- to medium-, and low-volume, but it reversed during the fourth period. The proportion of SUI surgeries decreased in medical centers, whereas it increased in regional and local hospitals. The proportion of SUI surgeries by female surgeons increased. Similar phenomena occurred in MUS. As for surgeon specialty, major surgical types were performed by gynecologists and urologists equally, whereas MUS were performed more by gynecologists than by urologists. Unexpectedly, 1-year reoperation rates were higher in high-volume surgeons.
Conclusions: The surgical trend of SUI surgeries shifted from high- to medium-, and low-volume surgeons, medical centers to regional and local hospitals during the study periods. This implied surgical skills and performance spreading, which may have a great influence on patient and healthcare provider choice of treatment.
(© 2022. The International Urogynecological Association.)
Databáze: MEDLINE
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