What Determines the Choice of Procedure in Stress Incontinence Surgery?: The Use of Multilevel Modeling

Abstract

The purpose of this study was to identify the determinants of choice of surgical procedure (anterior colporrhaphy, colposuspension, or needle suspension) to treat stress incontinence in women. We used multilevel modeling of data on 271 patients in 18 hospitals in England in 1993-94. Patient-related factors included sociodemographic details, anatomical diagnosis, symptom severity, symptom impact, previous treatment, parity, comorbidity, and general health status. Surgeon-related factors were specialty, grade, and annual volume of procedures undertaken. Hospital teaching status was considered. Some patient-related factors were associated with choice of procedure: women with a concomitant genital prolapse, with a history of high parity, and with no previous nonsurgical treatment were more likely to undergo an anterior colporrhaphy than a colposuspension or needle suspension (although this finding could be confounded by surgical specialty). In addition, women were more likely to be treated by colposuspension if their surgeon specialized in incontinence surgery (measured by annual volume of cases). Finally, being treated by needle suspension depended on there being a consultant surgeon familiar with the procedure at the hospital attended. While choice of surgical procedure depends partly on the patient's anatomical diagnosis, it is also dependent on the specialty of the surgeon whom she consults and the hospital that she attends. This variability, in turn, could have implications for the patient (as the relative effectiveness of the different procedures is unknown) and for the purchasers of care (as the relative cost-effectiveness of procedures is also unknown).

Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study

“…The different levels of hospital accreditation may mean that their doctors have different specialized surgical training including apprenticeship-style training, curriculum-and case-based programs, or independent and integrated specialty training programs [25]. Therefore, in addition to patient conditions, the choice of surgical procedures is dependent to some extent on the hospitals where the surgery is performed [12,26]. As for hospital ownership, more uterine suspensions were performed in private hospitals, followed by not-for-profit and government-owned hospitals; this may have been due to the more conservative, traditional character of government-owned hospitals.…”

The distribution of different surgical types for female stress urinary incontinence among patients’ age, surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

“…In addition to the patients' conditions, the choices of surgical procedures are partly dependent, to some extent, on the hospitals that they attend and the specialties of the surgeons with whom they consult [28]. This variability would, in turn, have implications for both the patients and the surgical modalities selected [28].…”

“…This variability would, in turn, have implications for both the patients and the surgical modalities selected [28]. There were significant differences in the distribution of the seven surgical types between hospital accreditation levels and types of hospital ownership.…”

A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women

“…Surgeons on the other hand may tend to interpret results over optimistically. In the recent study undertaken by Black et al 15–17 , 442 women having surgery for stress incontinence were recruited over an 18‐month period. Pre‐operative and post‐operative data were obtained both from surgeons and women themselves.…”