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Effect of surgeon volume on long-term quality of life outcomes following tension-free vaginal tape surgery

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Abstract

Introduction and hypothesis

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.

Methods

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.

Results

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.

Conclusions

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.

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Notes

  1. Three low-volume surgeons completed procedures both alone and supervised by a high-volume surgeon.

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Acknowledgements

The authors would like to thank the Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service for the provision of stationery and resources to complete this research. There are no other funding/affiliations to declare.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia

    Harold Baxter, Edward Carter, Rachael Nugent & Edward Weaver

  2. School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia

    Kelsi Marris

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  1. Harold Baxter
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Correspondence to Harold Baxter.

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Baxter, H., Carter, E., Marris, K. et al. Effect of surgeon volume on long-term quality of life outcomes following tension-free vaginal tape surgery. Int Urogynecol J 33, 2099–2106 (2022). https://doi.org/10.1007/s00192-021-04714-0

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