title: Retrospective cohort study on patterns of care and outcomes of surgical treatment for lower urinary-genital tract fistula among English National Health Service hospitals between 2000 and 2009.
abstract: OBJECTIVE
  To examine patterns of care among women with urogenital fistula treated in the English National Health Service (NHS) between 2000 and 2009. To assess whether failure of repair was associated with hospital or surgeon workload.
  
  
  METHODS
  We conducted a retrospective cohort study using data from Hospital Episode Statistics on women undergoing vesicovaginal or urethrovaginal fistula repair between January 2000 and December 2009 in English NHS hospitals. The main outcome measure was the number of fistula repairs and the incidence of re-repair; re-repair rates were stratified by age, NHS trust and consultant team volume.
  
  
  RESULTS
  Between 2000 and 2009, 1194 women underwent surgical repair (n = 905) or ileal conduit (n = 289) for urogenital fistula under the care of 490 consultant teams. A total of 281 teams performed only a single index procedure, and only three consultant teams performed a mean of >3 per year. The rate of unsuccessful repair was 11.9% (108/905). The rate of re-operation at NHS trusts who performed over 30 procedures over the 10-year study period was 7.4% compared with 13.2% at those undertaking fewer (P = 0.02). A similar difference in re-operations between consultant teams performing > or <30 procedures did not reach significance (8.4% v 12.7%, P = 0.13).
  
  
  CONCLUSIONS
  One in nine women required re-operation after surgical repair of a urogenital fistula. Our results lend weight to the argument for a 'minimum workload' for fistula management; given the number of fistulae occurring in England currently, this would best be provided by a network of supra-regional centres.
authors.affiliation: Office of Research and Clinical Audit, Royal College of Obstetricians & Gynaecologists and London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Cromwell
authors.forename: Paul
authors.initials: P
authors.lastname: Hilton
mesh_terms: D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D009313:National Health Programs; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D013222:State Medicine; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000601:surgery*