Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data

Abstract

ObjectivesTo explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP).Design and settingA retrospective cohort study employing administrative health data from the Tuscany region, Italy.ParticipantsAll women over 40 years hospitalised for apical/multicompartmental POP reconstructive surgery (excluding anterior/posterior colporrhaphy without concomitant hysterectomy) from January 2017 to December 2019.OutcomesWe first computed treatment rates just for women residing in Tuscany (n=2819) and calculated the Systematic Component of Variation (SCV) to explore variation in access to care among health districts. Then, using the full cohort (n=2959), we ran multilevel models for the average length of stay and reoperations, readmissions and complications, and computed the intraclass correlation coefficient to assess the individual and hospital determinants of efficiency and quality of care provided by hospitals.ResultsThe 5.4-fold variation between the lowest-rate (56/100 000 inhabitants) and the highest-rate (302/100 000) districts and the SCV over 10% confirmed high systematic variation in the access to care. Higher treatment rates were driven by greater provisions of robotic and/or laparoscopic interventions, which showed highly variable usage rates. Both individual and hospital factors influenced quality and efficiency provided by hospitals, but just low proportions of variation were explained by hospital and patient characteristics.ConclusionsWe found high and systematic variation in the access to POP surgical care in Tuscany and in quality and efficiency provided by hospitals. Such a variation may be mainly explained by user and provider preferences, which should be further explored. Also, supply-side factors may be involved, suggesting that wider and more uniform dissemination of robotic/laparoscopic procedures may reduce variation.

Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study

“…In our study, we showed to what extent LC surgery practices depend on the hospital type and size. Few studies have assessed national or regional variations in surgical practice [ 24 , 25 ]. One study, concerning congenital heart surgery, showed the disparity in the outcomes for this surgery according to the hospital and, in particular, the hospital volume.…”

“…The variability was not as marked for hospitals with a high volume [ 24 ]. The other study, from an Italian team, was focused on pelvic organ prolapse surgery and, in particular, the place of the approach (laparotomy or laparoscopy or robotic surgery) [ 25 ]. This very interesting study reported a wide variation in surgical practices between hospitals [ 25 ].…”

“…The other study, from an Italian team, was focused on pelvic organ prolapse surgery and, in particular, the place of the approach (laparotomy or laparoscopy or robotic surgery) [ 25 ]. This very interesting study reported a wide variation in surgical practices between hospitals [ 25 ]. The authors showed that 30.2% of variation for complications could be explained by disparities in individual and hospital characteristics [ 25 ].…”

“…This very interesting study reported a wide variation in surgical practices between hospitals [ 25 ]. The authors showed that 30.2% of variation for complications could be explained by disparities in individual and hospital characteristics [ 25 ]. We believe that a better understanding of these variations is necessary to improve the organization of care and that further studies are needed, whether on lung cancer or other conditions, particularly in the field of oncology.…”