Analysis of the BSUG database what does it tell us about ...
Transcript of Analysis of the BSUG database what does it tell us about ...
Birmingham Women'sNHS Foundation Trust
AnalysisoftheBSUGdatabasewhatdoesittellusabout
thefuture?
PhilipToozs-HobsonBirminghamWomen’sHospital
WiththankstoPaulMoranand
PhilAssassa
Birmingham Women'sNHS Foundation Trust
BSUGAuditDatabase
• AvailabletoallBSUGmembersfree• Needtoregistertouse• DataProtecHon
– NeedclinicalgovernanceandCaldicoJGuardianapproval
• SecureDataserver• OnlyUK
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BSUGAuditDatabase
• QuesHonaires– ICIQ-LUTSqol–Kings– ICIQ-UIShortForm– ICIQ–VS– ICIQ-OAB
• Consent• 142centresregistered• 68haveentereddata
• Medianepisodespercentre113(1-1726)• 44(65%)DGHandhaveentered68%ofdata
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BSUGAuditDatabase• 50,369operaHonsOct2013
486
2507
4918
72397716
8928
9928
8465
0
2000
4000
6000
8000
10000
12000
pre 2007 2007 2008 2009 2010 2011 2012 2013
75,098totalasofFeb201535920prolapseonly
39178inconHnence+/-prolapse
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InconHnencesurgeryintheUK
• 1,777(24%)alsohadprolapsesurgery• Nodeaths• Noneurologicalinjuries• Noper-operaHveDVTs• 90%primary10%repeatoperaHons• Allslingsrouteshadreportedbladderinjuries
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InconHnencesurgeryintheUK
67%
11%
12%
3%
3%
2%
2%
Retropubic Tape
TOT Outside in
TOT Inside out
Single incision
BNI
Colposuspension
Anterior repair andBladder neck buttress
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SecondaryProcedures
0 20 40 60 80 100
Anterior repair + BNB Artificial Urinary Sphincter
Laparoscopic Colposuspension Colposuspension-Open
Autologous Sling Cystoscopic BNI
Non-Cystoscopic BNI Retropubic MUS
Single Incision tape Stamey Procedure
TOT outside in TOT Inside out
Total
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ProceduresUnderlocal
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BladderInjuries
0 2 4 6 8 10 12 14 16
Anterior repair + BNB
Colposuspension-Open
Autologous Sling
Retropubic MUS
Single Incision tape
TOT outside in
TOT Inside out
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>500mlBloodloss(%)
0 0.5 1 1.5 2 2.5 3 3.5
Colposuspension-Open
Non-Cystoscopic BNI
Retropubic MUS
TOT outside in
TOT Inside out
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Consultant StaffgradeSubspecTrainee
(SST)SpecialityTrainee(ST) FTSTA Unanswered
Anteriorrepair(AR)+BNB 112(89.6) 1(0.8) 4(3.2%) 4(3.2) 0 4
ArHficialUrinarySphincter 0 0 1(100) 0 0 0
Laparoscopiccolposuspension 16(88.9) 0 0 2(11) 0 0
Colposuspension-Open
95(74.8) 0 26(20.5) 3(2.4) 0 3(2.4)AutologuseSling 14(100) 0 0 0 0 0CystoscopicBNI 111(77.6) 1(0.7) 8(5.6) 15(10.5) 0 8Non-CystoscopicBNI
62(75.6) 0 4(4.9) 14(17.1) 0 2
RetropubicMUSBladderperforaHons(%)
3486(71.1)61(1.7%)
97(2)9(9.3%)
346(7.1)11(3.2%)
822(16.8)71(8.6%)
22(100%)
1476(4.1%)
SingleIncisiontape191(89.3) 2(0.9) 3(1.4) 11(5.1) 0 7(3.3)
StameyProcedure 2(50) 0 0 2(50) 0 0TOTOutsideIn 636(79) 13(1.6) 45(5.6) 82(10.2) 4(0.5) 25(3)TVTInsideout 642(72.9) 14(1.6) 32(3.6) 153(17.4) 0 40(4.4)
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OperaHonsbyleadsurgeon
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BladderperforaHonsbysurgeon
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Mytotalcases
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Unittotalcases
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Mytapes
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UnitTapes
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Retropubicslingoutcomes
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Governanceofnewprocedures
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Newprocedures
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5-8yearfollowup77%responsebe$er Symp Re-op details
anterior primary 17 94% 1 0
Re-do 5 40% 3 0 2withmesh
posterior primary 47 75% 4 1 1rectopexy
Re-do 15 60% 2 0
central primary 13 92% 1 0
Re-do 8 88% 0 0
Central&ant primary 18 88% 0 0
Re-do 2 100% 0 0
Central&post primary 10 70% 3 0
Re-do 9 66% 2 2 BothIVS
A&P primary 9 89% 1 1
Re-do 14 64% 0 0
VHA&P primary 12 92% 1 0
Re-do 1
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JosephPick1,PhilipToozs-Hobson2,ClareBurton3,Philip
Assassa4&PaulMoran5
TunbridgeWellsHospital1,BirminghamWomen’sHospital2,PortsmouthAcuteTrust3PinderfieldsHospital4WorcesterAcuteTrust5
DoestheBSUGdatabaseimproveourunderstanding?
Analysisofretropubictapesbyage
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Results• Dataretrieved
– 7600caseswereidenHfied– 757(10%)were70yearsoldormore.– 80%hadaretropubictape.– Primaryoutcomemeasureswereonlyrecordedin54-64%ofcases.
• PrimaryOutcomes:– AreducHoninsubjecHvecurein>70yrscomparedto<50yrs– ReducHoninPGII70-79yearsp=0.000,>80yearsp=0.037.– Cure/improvementinSUIsignificantlyreducedinthe70-79(p<0.01)
• Secondaryoutcomes:– Nodifferenceintheintra-operaHveorpostoperaHvecomplicaHons.– Morewomeninthe80+grouprequiredacatheterformorethan10days.
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Results• PrimaryOutcomes:
– AreducHoninsubjecHvecurein>70yrscomparedto<50yrs
– ReducHoninPGII70-79yearsp=0.000,>80yearsp=0.037.– Cure/improvementinSUIsignificantlyreducedinthe70-79(p<0.01)
• Secondaryoutcomes:– Nodifferenceintheintra-operaHveorpostoperaHvecomplicaHons.
– Morewomeninthe80+grouprequiredacatheterformorethan10days.
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Conclusion
• ThisstudyshowstheuHlityofcontribuHngtoanaHonaldatabase.
• Successratesreduceslightlywithage.
• RessuringlysurgeryintheelderlyisnotassociatedwithincreasedriskofcomplicaHonsotherthanvoiding.
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MinimumstandardsforconHnencecareintheUK
• AngieRantell,LuciaDolan,LizBonner,StephanieKnight,CarmelRamageandPhilipToozs-Hobson
• publishedonline:16JAN2015
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HQIPP
• Whyisimportant…..• NaHonalaudits…
– Cardiovascularsurgeonsentforre-training– Jointregistry
• InfluencesnaHonalpolicy
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Conclusions(sHck)
• Knowingyouroutcomesisimportant– PaHentswantrelevantdata
• Beingabletocompareisimportant– AuthoriHeswantconfidence
• IncreasingscruHnyinevitable
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Conclusions(Carrot)
• Whowouldn’twanttoknowtheirdata?– Reassuringifgood– EarlyindicaHontochange(beforepush)– Trustlikeustobeaheadofthecurve– DifficultforpaHentstosaynotinformed
• UnitaccreditaHonbringsthingstogether
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