Up to seven-fold inter-hospital differences in obstetric anal sphincter injury rates- A birth register-based study in Finland

<p>Abstract</p> <p>Background</p> <p>The occurrence of obstetric anal sphincter injuries (OASIS) - which may have serious, long-term effects on affected women, including faecal incontinence, despite primary repair - varies widely between countries and have been chosen one of the indicators for patient safety in Organisation for Economic Cooperation and Development (OECD) countries and in Nordic countries.</p> <p>Findings</p> <p>The aim of the study was to assess risks of OASIS among five university teaching hospitals and 14 non-university central hospitals with more than 1,000 deliveries annually during 1997-2007 in Finland. Women with singleton vaginal deliveries divided into two populations consisting of all 168,637 women from five university hospitals and all 255,660 women from non-university hospitals, respectively, derived from population-based register. Primiparous and multiparous women with OASIS (n = 2,448) were compared in terms of possible risk factors to primiparous and multiparous women without OASIS, respectively, using stepwise logistic regression analysis. The occurrences of OASIS varied from 0.7% to 2.1% in primiparous and from 0.1% to 0.3% in multiparous women among the university hospitals. Three-fold inter-hospital differences in OASIS rates did not significantly change after adjustment for patient mix or the use of interventions. In non-university hospitals OASIS rates varied from 0.2% to 1.4% in primiparous and from 0.02% to 0.4% in multiparous women, and the results remained virtually unchanged after adjustment for known risks.</p> <p>Conclusions</p> <p>Up to 3.2-fold inter-hospital differences in OASIS risk demonstrates significant differences in the quality of Finnish obstetric care.</p

A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth

© 2018, The International Urogynecological Association. Introduction and hypothesis: Anal incontinence following childbirth is prevalent and has a significant impact upon quality of life (QoL). Currently, there is no standard assessment for women after childbirth to identify these symptoms. This systematic review aimed to identify non-invasive modalities used to identify women with anal incontinence following childbirth and assess response and reporting rates of anal incontinence for these modalities. Methods: Ovid Medline, Allied and Complementary Medicine Database (AMED), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Collaboration, EMBASE and Web of Science databases were searched for studies using non-invasive modalities published from January 1966 to May 2018 to identify women with anal incontinence following childbirth. Study data including type of modality, response rates and reported prevalence of anal incontinence were extracted and critically appraised. Results: One hundred and nine studies were included from 1602 screened articles. Three types of non-invasive modalities were identified: validated questionnaires/symptom scales (n = 36 studies using 15 different instruments), non-validated questionnaires (n = 50 studies) and patient interviews (n = 23 studies). Mean response rates were 92% up to 6 weeks after childbirth. Non-personalised assessment modalities (validated and non-validated questionnaires) were associated with reporting of higher rates of anal incontinence compared with patient interview at all periods of follow-up after childbirth, which was statistically significant between 6 weeks and 1 year after childbirth (p < 0.05). Conclusions: This systematic review confirms that questionnaires can be used effectively after childbirth to identify women with anal incontinence. Given the methodological limitations associated with non-validated questionnaires, assessing all women following childbirth for pelvic-floor symptomatology, including anal incontinence, using validated questionnaires should be considered

Outcome of 200 restorative proctocolectomy operations: the John Radcliffe Hospital experience.

BACKGROUND: Restorative proctocolectomy is now the operation of choice for the definitive management of ulcerative colitis and familial adenomatous polyposis (FAP). METHODS: A total of 200 patients (117 male, 83 female) underwent restorative proctocolectomy over a 12-year period. Information in a dedicated prospective database was supplemented by chart review. Some 177 had ulcerative colitis, 13 had indeterminate colitis and seven had FAP. Pouch designs were two-loop J (n = 142), four-loop W (n = 45) and three-loop S (n = 13). The majority (73.5 per cent) had a stapled ileoanal anastomosis and 139 patients had a defunctioning ileostomy. RESULTS: There were no deaths. Early morbidity (less than 30 days after operation) included 76 complications in 71 patients (35.5 per cent), of which 35 were related to the pouch itself. Long-term follow-up data were available for 196 patients at a median of 27 months. Sixteen pouches (8.0 per cent) have been excised. Mean daytime frequency was 4.5 (range 1-15). Of 175 patients with colitis, 42 (24.0 per cent) had one or more episodes of pouchitis. CONCLUSION: Continuous improvements in operative technique have simplified the procedure, and functional results, although variable, have generally been acceptable