Urinary incontinence in women: Study of surgical practice in France

Desseauve, David; Pierre, Fabrice H.F.; Fritel, Xavier

doi:10.1016/j.purol.2012.12.005

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…One of the advantages of MUS for the treatment of incontinence is precisely the possibility of subsequent adjustment of the sling, which is not possible for other surgical procedures for SUI (retropubic colposuspension or traditional sling). Around 30 000 midurethral slings are placed annually in France . The number of surgical revisions seen in our registry in the early months after the placement of MUS alone was around 3.8% and may thus indicate that there are around 1100 reoperations for this procedure each year in France.…”

Section: Discussionmentioning

confidence: 82%

Complications after pelvic floor repair surgery (with and without mesh): short‐term incidence after 1873 inclusions in the French VIGI‐MESH registry

Fritel

Campagne-Loiseau

Cosson

et al. 2019

BJOG

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Objective To assess the short‐term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. Design Prospective longitudinal cohort study using a surgical registry. Setting Thirteen public hospitals in France. Population A cohort of 1873 women undergoing surgery between February 2017 and August 2018. Methods Preliminary analysis of serious complications after a mean follow‐up of 7 months (0–18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals’ information systems. Main outcome measures Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life‐threatening complication requiring resuscitation, or death. Results Fifty‐two women (2.8%, 95% CI 2.1–3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow‐up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7–2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1–1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2–1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0–5.0%) after MUS alone, 7.0% (2.8–11.3%) after MUS with prolapse surgery, 1.7% (0.0–3.8%) after vaginal native tissue repair, 2.8% (0.9–4.6%) after transvaginal mesh, and 1.0% (0.1–1.9%) after laparoscopy with mesh. Conclusions Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long‐term risk associated with mesh use and to identify its risk factors. Tweetable abstract Short‐term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.

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Section: Discussionmentioning

confidence: 82%

Complications after pelvic floor repair surgery (with and without mesh): short‐term incidence after 1873 inclusions in the French VIGI‐MESH registry

Fritel

Campagne-Loiseau

Cosson

et al. 2019

BJOG

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“…DRGs can help monitor the health of the general population, for example by detecting disease incidence (Quantin, 2012) and by assessing the prevalence of specific ailments such as cancer (Hafdi-Nejjari et al, 2006;Theis et al, 2007) via epidemiological studies (Olive et al, 2011;Bernier et al, 2012;Fernandez et al, 2014) (Nuemi et al, 2013). DRGs can also help understand changes in surgical practices, as the patient discharge summary specifies the type of medical procedure that was performed on the patient (Desseauve et al, 2013). Hence, DRGs appear to have succeeded in monitoring diseases on the macro level.…”

Section: The Limits Of Drg Relevancymentioning

confidence: 99%

Critical Evaluations of the French Health Care Accounting Indicators: The Use of Drgs

Simonet,

Alkafaji

2017

Public Administration Quarterly

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Responding to legitimate public demand for a more effective government, and pressed by EU authorities to achieve fiscal balance, and to reorient the economy toward an export model (Lux, 2015), French authorities embraced New Public Management (NPM). The aims were: to modernize the public sector; to introduce some elements of economic performance in the administration; and to enhance accountability (Bezes, 2008). The health care sector was not spared. Diagnostic-Related Groups (DRG) was one of the new accounting tools designed to effect changes in this sector. The purpose of this paper is to critically evaluate the appropriateness of the DRG system and the challenges associated with its implementation in the health system. We evaluate the impact of DRGs using the four evaluation dimensions of the World Health Organization: efficiency, quality, relevancy and equity. Our findings indicate that although DRGs contributed to improving the relevance of the system and its efficiency (the ‘reality axis’ of WHO model), it has failed to meet what the society expects of an ‘ideal’ health care system: an increase in the quality of care and the promotion of equity between public and private care providers (the ‘ideal axis’ of the WHO model).

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“…On a positive note, NPM encourages greater coordination between medical specialties and between general practitioners and specialists (Mas et al., 2011). DRGs eased the conduct of nationwide epidemiological studies (Desseauve et al., 2013; Gaudin et al., 2012), thereby raising awareness about certain public emergencies, such as medically underserved areas (Chasles et al., 2013) and the prevalence of chronic diseases among the youth; they helped understand changes in surgical practices (DRGs track the type of procedures performed); and they emphasized environmental health and prevention. Performance has become more important (Routelous, 2014).…”

Section: Reforms and The Medical Professionmentioning

confidence: 99%

Reforming the French health-care system: the quest for accountability

Simonet

2016

International Review of Administrative Sciences

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The resurgence of New Right politics in the late 1970s and 1980s (e.g. ‘Reaganomics’ and ‘Thatcherism’), which were pro-market and pro-private sector ( Lorenz, 2012 ), has increased the reliance on the private sector for the provision of public services. In France, the support for the private sector is no longer a partisan or ideological issue, but rather a pragmatic and increasingly routine approach to the delivery of public services. Whether this will improve the efficiency of the health-care system is still open to question. The article: investigates the use of the New Public Management toolbox ( Goldfinch and Wallis, 2009 : 151) in the French health-care system; examines its selective adoption; and assesses its impact on the accountability and transparency of the medical profession. The French government eventually opted for a re-centralization of the health-care system for monitoring purposes. The reforms antagonized the medical profession and strengthened private care providers. Point for practitioners Despite reiterated calls for devolution, the implementation of New Public Management in the French health-care system led to a greater re-centralization and rising regulations for efficiency purposes. It also allowed the French administrative elite to regain its prerogatives and regional health agencies to reform more rapidly than a multitude of local public organizations. The quest for greater accountability remains an ongoing process.

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Urinary incontinence in women: Study of surgical practice in France

Cited by 9 publications

References 20 publications

Complications after pelvic floor repair surgery (with and without mesh): short‐term incidence after 1873 inclusions in the French VIGI‐MESH registry

Complications after pelvic floor repair surgery (with and without mesh): short‐term incidence after 1873 inclusions in the French VIGI‐MESH registry

Critical Evaluations of the French Health Care Accounting Indicators: The Use of Drgs

Reforming the French health-care system: the quest for accountability

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