Retrospective cohort study on patterns of care and outcomes of surgical treatment for lower urinary–genital tract fistula among English National Health Service hospitals between 2000 and 2009

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Author(s)Cromwell D, Hilton P
Publication type Article
JournalBJU International
Year2013
Volume111
Issue4b
PagesE257-E262
ISSN (print)1464-4096
ISSN (electronic)1464-410X
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0 0 1 245 1403 Newcastle Upon Tyne Hospitals NHS Foundation Trust 11 3 1645 14.0 Normal 0 false false false EN-US JA X-NONE Objectives · To examine patterns of care among women with urogenital fistula treated in the English National Health Service (NHS) between 2000 and 2009 · To assess whether failure of repair was associated with hospital or surgeon workload. Patients and methods · This is a retrospective cohort study using data from Hospital Episode Statistics on women undergoing vesico-vaginal or urethro-vaginal fistula repair between January 2000 and December 2009 in English NHS hospitals. · The main outcome measure is the number of fistula repairs and the incidence of re-repair; re-repair rates were stratified by age, NHS trust and consultant team volume. Results · Between 2000 and 2009, 1194 women underwent surgical repair (n=905) or ileal conduit (n=289) for urogenital fistula under the care of 490 consultant teams. · 281 teams performed only a single index procedure, and only three consultant teams performed more than three per year on average. · The rate of unsuccessful repair was 11.9% (108/905). · The rate of re-operation at NHS trusts who performed over 30 procedures over the 10-year study period was 7.4% compared to 13.2% at those undertaking fewer (p=0.02). · A similar difference in re-operations between consultant teams performing more or less than 30 procedures did not reach statistical significance (8.4% v 12.7%, p=0.13). Conclusion · One in nine women required reoperation after surgical repair of a urogenital fistula.
PublisherWiley-Blackwell Publishing Ltd.
URLhttp://dx.doi.org/10.1111/j.1464-410X.2012.11483.x
DOI10.1111/j.1464-410X.2012.11483.x
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