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Developing a Risk-Adjustment Model for Stress Urinary Incontinence Procedures Using Australasian Pelvic Floor
Stanley Johnson1, Mohammad Amin Honardoost1, Susannah Ahern1
1School of Public Health and Preventive Medicine, Monash University, Room 415, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Introduction And Hypothesis:
Surgical outcomes for stress urinary incontinence (SUI) procedures are influenced by factors beyond the surgeon's control. Using Australasian Pelvic Floor Procedure Registry data, this study is aimed at developing a risk-adjustment model for equitable benchmarking of clinician-reported outcomes for female SUI procedures.
Methods:
Logistic regression was used to create multivariate models for clinician-reported outcomes of primary SUI procedures. Risk factors such as age, body mass index (BMI), diabetic status, and symptoms of bladder disease were selected for adjustment after consultation with clinicians. Sensitivity analysis was conducted to ensure the robustness of the primary model.
Results:
The multivariate model for clinician-reported improvement indicated that age over 80 years (OR 3.09, 95% CI 1.55 to 6.16, p = 0.001), BMI within the obese range (OR 2.67, 95% CI 1.03 to 6.98, p = 0.044), and a history of overactive bladder (OR 2.08, 95% CI 1.19 to 3.63, p = 0.010) were significantly associated with poorer outcomes. The model showed an acceptable fit, with an area under the curve of 68.38%.
Conclusions:
Clinician-reported outcomes for primary SUI procedures in women are significantly affected by age, BMI and pre-existing bladder disease. This model can be used to statistically adjust for differences in case-mix across different clinical facilities, allowing for unbiased and equitable benchmarking of surgical outcomes.