NHS Digital Data Release Register - reformatted

Poole Hospital NHS Foundation Trust

Project 1 — DARS-NIC-82980-V6D4Q

Opt outs honoured: N

Sensitive: Non Sensitive

When: 2017/03 — 2017/05.

Repeats: Ongoing

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care

Benefits:

Laparoscopic hysterectomies offer significant advantages to the patient in terms of recovery and to the NHS in terms of admission time. One of the benefits of this study would be an up to date understanding of currently practice which is not available in the literature elsewhere. This will allow the BSGE to provide targeted training in laparoscopic surgery with the aim to improve care provided for patients. The BSGE are aiming to provide more training to gynaecologists in order that this can be offered to patients where clinically possible and an understanding of current practice would be of use. Laparoscopic hysterectomies where possible (versus abdominal hysterectomies) convey massive benefits to the patients in terms of recovery, complication rates and return to work and hospital in terms of length of stay (1 night versus 2+ nights). It is now an established procedure but requires a certain set of skills and is not routine practice but is considered the gold standard amongst those leading the field and should be offered to suitable women in place of open abdominal surgery NICE guidance in relation to non-cancer hysterectomies is now 10 years old and considered amongst practising gynaecologists to be out of date. Current NICE guidance recommends laparoscopic hysterectomy in the case of endometrial cancer (2010) with the caveat that advanced laparoscopic skills are required for such procedures, therefore clinicians should undergo special training and mentorship. RCOG has developed an Advanced Training Skills Module, 'Benign Gynaecological Surgery: Laparoscopy' - this would need to be supplemented by further training in order to achieve the skills required for total laparoscopic hysterectomy. Over the last 2-3 years the BSGE has developed training pathways to enable gynaecologists to develop skills in offering this to women also with benign disease. (National laparoscopic hysterectomy training pathway for consultants, Olympus and Ethicon TLH training pathway) Receiving this data would allow Poole Hospital NHS Trust on behalf of BSGE to monitor their performance in offering this procedure on a national basis and the evolution over time. It would allow further development of training opportunities with a knowledge as to geographical differences in practice as well as with regards to indication of surgery. Data on an ongoing basis would allow some indication of progression.

Outputs:

The output will be a report which will be presented at the Annual Scientific Meeting for the BSGE in May 2017 and also submitted to the British Journal for Obstetrics and Gynaecology (BJOG) for publication following this. The report will be of interest to all practising gynaecologists in the UK and the aim is to submit the report for publication in the BJOG. The results will be made available to patient groups such as Endometriosis UK will also be present. It is anticipated the output will be used to influence NICE guidelines and other national guidelines from the RCOG. The report will be shared directly with NICE. This will be particularly important should the readmission rates show a significant difference from previous data, as the guidance around this area is quite old. Outputs will contain only aggregate level data with small numbers suppressed in line with HES analysis guide.

Processing:

All data processing will take place at Poole Hospital. Access to the record level data is limited to three individuals who are substantive employees of either the data controller or data processor. - The total number of hysterectomies and each route will be calculated from the data set - This will be split by year, trust, diagnosis, age and ethnicity - No data will be linked to record patient level data - There will be no linkage with other datasets - Outputs will contain aggregate level data will be presented to the BSGE - Any data presented will be in aggregate form only with small numbers suppressed in line with the HES analysis guide - no record level data will be presented

Objectives:

The data will be processed at Poole Hospital on behalf of the BSGE (British Society for Gynaecological Endoscopy) by BGSE members, to ascertain the numbers of hysterectomies carried out per year and the route of the procedure (abdominal, vaginal, laparoscopic (including robotic). Currently there are approximately 50,000 hysterectomies annually but the division between vaginal/abdominal and laparoscopic is not clear. Poole Hospital had undertaken a similar audit by using the OPSC4 codes in order to ascertain the accuracy of this method of estimating hysterectomy. Poole Hospital compared retrieval of episodes using OPCS4 codes against personal surgical logs of cases and this had an error rate for 3%, which was felt to be acceptable. The BSGE was founded to promote minimal access surgery for women with gynaecological problems. It aims to improve standards, promote training and encourage the exchange of information. It engages clinicians, patients, industry and those that form healthcare policy are involved in writing national guidelines both for the Royal College of Obstetricians and Gynecologists (RCOG) and the National Institute for Health and Care Excellence (NICE). The BSGE are supporting and funding this work in order to fully understand the current patterns of practice throughout the UK. The current hypothesis is that laparoscopic procedures would be superior to abdominal surgery where possible due to reduced length of stay, improved recovery rates and fewer complications. The BSGE also hypothesises that although there may have been an improvement over time in this being offered, there is still geographical variation with overall abdominal hysterectomy prevailing. Current NICE guidance about laparoscopic hysterectomy is out of date (2007). NICE recommend laparoscopic hysterectomy for women with endometrial cancer (2010). The BSGE advocate that where it is clinically possible laparoscopic hysterectomy would be the preferred route of hysterectomy over abdominal hysterectomy as it had reduced rates of patient complications and hospital stay as well as improved rates of recovery and return to work for women. NICE guidance currently also states that those that perform hysterectomy should have additional training as it requires a specific set of skills. Laparoscopic hysterectomy was a relatively new procedure 10 years ago and techniques have significantly evolved since that time but many practicing gynaecologists would not have the skill set required to offer it to women. Over the last few years the BSGE have taken a number of initiatives to improve access to training for this procedure such as The National Hysterectomy Training program for Consultants and Hysterectomy Training pathway with Ethicon and Olympus. Current practice with regards to route of hysterectomy (vaginal versus abdominal versus laparoscopic) is unknown on a national level. The aim of this Audit is to ascertain current practice with variation according to diagnosis, patient demographics and geography. This audit would allow us to describe current practice and how this has evolved over the last few years where BSGE initiatives have been undertaken. It will also allow identification of inequity in this practice and allow us to promote and provide training appropriately.