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What determines the choice of procedure in stress incontinence surgery? The use of multilevel modeling

Griffiths, Joanne M., Black, Nicholas A., Pope, Catherine, Stanley, Jenny, Bowling, Ann and Abel, Paul D. (1998) What determines the choice of procedure in stress incontinence surgery? The use of multilevel modeling International Journal of Technology Assessment in Health Care, 14, (3), Summer Issue, 431 - 445. (doi:10.1017/S0266462300011417). (PMID:9780530).

Record type: Article


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).

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Published date: 1998
Keywords: urinary incontinence, stress incontinence, surgery
Organisations: Faculty of Health Sciences


Local EPrints ID: 334758
ISSN: 0266-4623
PURE UUID: 4a06e541-2580-4197-8428-fc83ef1a839c
ORCID for Catherine Pope: ORCID iD

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Date deposited: 23 Mar 2012 11:12
Last modified: 18 Jul 2017 06:11

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Author: Joanne M. Griffiths
Author: Nicholas A. Black
Author: Catherine Pope ORCID iD
Author: Jenny Stanley
Author: Ann Bowling
Author: Paul D. Abel

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