Understanding The Graphs
We have attempted to indicate the quality of data entry for urethroplasty by:
- validating the BAUS data by comparing with Hospital Episode Statistics (HES) - this is information collected by every NHS hospital after a patient’s discharge from a surgical procedure. Unfortunately, HES data are not 100% reliable for stricture surgery because procedures may be coded differently in different hospitals; we are currently investigating how to make this coding more accurate in the future. Ideally, all procedures recorded on HES will be entered by the surgeon on to the BAUS database for analysis. A coding percentage close to 100% suggests good recording; a percentage higher than this may indicate incorrect HES coding of procedures at the individual surgeon's hospital and a low percentage suggests incomplete recording by the surgeon or, again, poor HES coding.
- measuring the interval between the procedure and data entry - a long delay may influence the accuracy of recording of details, and of any complications that arise, either during surgery or in the 30 days after. Ideally, the interval between a urethroplasty and data entry should be less than 30 days.
- measuring the percentage of patients for whom follow up data is recorded - ideally, at least 85% of patients should have completed follow-up assessment, to give a realistic picture of expected outcomes.
Scope of practice
This is an indication of the volume of urethral surgery carried out by an individual surgeon and unit, and is displayed as the number of cases carried out during the audit period. Higher numbers indicate a larger reconstructive practice.
Outcomes data for bulbar urethroplasty
The outcomes from bulbar urethroplasty can, at the present time, only be determined by looking at:
- the length of stay following the operation - this can be influenced by an individual patient’s general health, logistical issues (such as the distance they live from where the surgery is carried out), and individual surgeons' practice,
- the complication rates during (and in the 30 days after) surgery - complication recording may be influenced by the percentage of follow-ups performed, the interval between the operation and outpatient appointment, and data entry / data field completion. What appear to be high complication rates may be seen where there has been assiduous recording of all deviations from an expected clinical course. When BAUS began collection of these data, complications were not graded by severity, although they are now. An apparently high complication rate may also occur when little follow-up data has been entered but that which has contains an isolated, or small number of, complications. Where high complication rates are reported, further enquiries are made, and explanations sought from the surgeons concerned; these explanations are summarised on individual surgeon's outcome pages.
- the urine flow rate at outpatient review - the urine flow rate is an indication of how effective the urethroplasty has been but it may be influenced by abnormal bladder function, and by the volume of urine passed at the time of the test.