Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Int Urogynecol J. 2022 Aug;33(8):2099-2106. doi: 10.1007/s00192-021-04714-0. Epub 2021 Mar 24.
The role of the general obstetrician/gynaecologist completing routine urogynaecology procedures is controversial, and some research has suggested that these patients should be referred to high-volume subspecialists. In response to recent public and regulatory scrutiny of vaginal mesh procedures, credentialling guidelines have been released in Australia requiring surgeons to demonstrate a minimum caseload prior to performing tension-free vaginal tape (TVT) surgery for incontinence. Hence, a retrospective cohort study was conducted to evaluate the long-term quality of life outcomes of TVT procedures for high- and low-volume surgeons.
One hundred seventy patients who had undergone TVT surgery between 1 May 2011 and 1 May 2016 in the Sunshine Coast health district were invited to complete the UDI-6 (Urinary Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) surveys. Perioperative information was accessed from available health records. Mean UDI-6 and IIQ-7 scores were compared for high- and low-volume groups, and the groups were assessed for confounding factors.
Of the 170 patients eligible, 83 completed the surveys (47.2%). No differences in UDI-6 or IIQ-7 scores were found between high- and low-volume surgeons (p > 0.05). High-volume surgeons completed more concomitant procedures amongst survey respondents (p < 0.05), though this was not reproduced when considering all 170 patients eligible for the study. There were no significant differences in age, ASA (American Society of Anaesthesiologists) score or complication rate amongst survey respondents.
Amongst the patients surveyed, high- and low-volume surgeons had similar long-term quality of life outcomes for TVT surgery, without any significant difference in complication rate.
妇产科医生完成常规泌尿妇科手术的角色存在争议，一些研究表明这些患者应转介给高容量的亚专科医生。针对最近对阴道网片手术的公众和监管审查，澳大利亚发布了认证指南，要求外科医生在进行用于治疗尿失禁的无张力阴道吊带（TVT）手术之前，展示出最低的病例量。因此，进行了一项回顾性队列研究，以评估高容量和低容量外科医生进行 TVT 手术的长期生活质量结果。
邀请了 170 名在阳光海岸卫生区于 2011 年 5 月 1 日至 2016 年 5 月 1 日期间接受 TVT 手术的患者完成 UDI-6（尿困扰量表）和 IIQ-7（尿失禁影响问卷）调查。从可用的健康记录中获取围手术期信息。比较高容量和低容量组的平均 UDI-6 和 IIQ-7 评分，并评估两组的混杂因素。
在 170 名符合条件的患者中，有 83 名完成了调查（47.2%）。高容量和低容量外科医生之间的 UDI-6 或 IIQ-7 评分没有差异（p>0.05）。高容量外科医生在接受调查的患者中完成了更多的同时进行的手术（p<0.05），但在考虑所有符合研究条件的 170 名患者时，并未重现这种情况。在接受调查的患者中，年龄、ASA（美国麻醉师协会）评分或并发症发生率没有显著差异。
在所调查的患者中，高容量和低容量外科医生的 TVT 手术长期生活质量结果相似，并发症发生率没有显著差异。
