Download - Analysis of the BSUG database what does it tell us about ...

Birmingham Women'sNHS Foundation Trust

AnalysisoftheBSUGdatabasewhatdoesittellusabout

thefuture?

PhilipToozs-HobsonBirminghamWomen’sHospital

WiththankstoPaulMoranand

PhilAssassa


BSUGAuditDatabase

•  AvailabletoallBSUGmembersfree•  Needtoregistertouse•  DataProtecHon

– NeedclinicalgovernanceandCaldicoJGuardianapproval

•  SecureDataserver•  OnlyUK


BSUGAuditDatabase

•  QuesHonaires–  ICIQ-LUTSqol–Kings–  ICIQ-UIShortForm–  ICIQ–VS–  ICIQ-OAB

•  Consent•  142centresregistered•  68haveentereddata

•  Medianepisodespercentre113(1-1726)•  44(65%)DGHandhaveentered68%ofdata


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


InconHnencesurgeryintheUK

•  1,777(24%)alsohadprolapsesurgery•  Nodeaths•  Noneurologicalinjuries•  Noper-operaHveDVTs•  90%primary10%repeatoperaHons•  Allslingsrouteshadreportedbladderinjuries


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


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


ProceduresUnderlocal


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


>500mlBloodloss(%)

0 0.5 1 1.5 2 2.5 3 3.5


Non-Cystoscopic BNI

Retropubic MUS

TOT outside in

TOT Inside out


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


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)


OperaHonsbyleadsurgeon


BladderperforaHonsbysurgeon


Mytotalcases


Unittotalcases


Mytapes


UnitTapes


Retropubicslingoutcomes


Governanceofnewprocedures


Newprocedures


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


JosephPick1,PhilipToozs-Hobson2,ClareBurton3,Philip

Assassa4&PaulMoran5

TunbridgeWellsHospital1,BirminghamWomen’sHospital2,PortsmouthAcuteTrust3PinderfieldsHospital4WorcesterAcuteTrust5

DoestheBSUGdatabaseimproveourunderstanding?

Analysisofretropubictapesbyage


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.


Results•  PrimaryOutcomes:

–  AreducHoninsubjecHvecurein>70yrscomparedto<50yrs

–  ReducHoninPGII70-79yearsp=0.000,>80yearsp=0.037.–  Cure/improvementinSUIsignificantlyreducedinthe70-79(p<0.01)

•  Secondaryoutcomes:–  Nodifferenceintheintra-operaHveorpostoperaHvecomplicaHons.

– Morewomeninthe80+grouprequiredacatheterformorethan10days.


Conclusion

•  ThisstudyshowstheuHlityofcontribuHngtoanaHonaldatabase.

•  Successratesreduceslightlywithage.

•  RessuringlysurgeryintheelderlyisnotassociatedwithincreasedriskofcomplicaHonsotherthanvoiding.


MinimumstandardsforconHnencecareintheUK

•  AngieRantell,LuciaDolan,LizBonner,StephanieKnight,CarmelRamageandPhilipToozs-Hobson

•  publishedonline:16JAN2015


HQIPP

•  Whyisimportant…..•  NaHonalaudits…

– Cardiovascularsurgeonsentforre-training–  Jointregistry

•  InfluencesnaHonalpolicy


Conclusions(sHck)

•  Knowingyouroutcomesisimportant– PaHentswantrelevantdata

•  Beingabletocompareisimportant– AuthoriHeswantconfidence

•  IncreasingscruHnyinevitable


Conclusions(Carrot)

•  Whowouldn’twanttoknowtheirdata?– Reassuringifgood– EarlyindicaHontochange(beforepush)– Trustlikeustobeaheadofthecurve– DifficultforpaHentstosaynotinformed

•  UnitaccreditaHonbringsthingstogether