VALUE BASED HEALTHCARE: THE EFFECTOF BODY MASS INDEX (BMI) ON SUCCESS AND COMPLICATIONS OF 12,000 MIDURETHRAL SLINGS (MUS).
F. BACH 1, P.TOOZS-HOBSON2, S. HILL 3;
1BirminghamWomen's Hosp., Birmingham, United Kingdom, 2Birminghamwomen's Foundaiton NHS Trust, Birmingham, United Kingdom, 3EastLancashire Hosp., Lancashire, United Kingdom.
Introduction: Analysing surgicaldatabases utilises “real life” outcomes rather than highlyselected cases from RCTs or meta-analysis and may be more valid forplanning health services/resources. MUS are the gold standardsurgical treatment for stress urinary incontinence (SUI) but risksmust be explained to patients. Patient characteristics may alteroutcomes, rendering treatments less effective with less “value”in management pathways. It is important to identify thesecharacteristics, particularly if modifiable, so patients andclinicians can be fully informed.
Objective: To evaluatethe effect of a single modifiable variable: BMI, on patient reportedoutcomes by analysing MUS on the BSUG database.
Methods:BSUG approved analysis of 11859 anonymised MUS from 2007 - 2016. Datawere analysed using excel and Chi2.
Results:Outcome 1. As BMI increases, patient global impression of improvement(PGI-I) declines. Women with a normal (18-<25) BMI reportvery much better/much better PGI-I in 91.6% of cases. Fewer patientsin BMI groups >30 reported this level of success (87.7-72%)(p<0.05). (Graph 1)
Outcome 2. Patient reported outcomes forSUI inversely correlated to BMI with 97% of normal BMI statingthey were cured/improved compared to 35-40 (94%), 40-45 (93%) and45-50 (84%) (p<0.05) (Graph 2).
Outcome 3. Patient reportedoutcomes for overactive bladder (OAB) show that as BMIincreases, higher rates of patients report worsening symptoms(p<0.05). (Graph 3)
Outcome 4. There is a u-shaped associationbetween BMI and perforation rate (p<0.05).
Conclusions:Our results suggest that raised BMI is associated with pooreroutcomes, and this potentially modifiable variable may lead to anoverall lower “value” to the patient.
By definingcharacteristics that alter outcomes there is the potential tocalculate a personalised prediction of success and complications.This may improve shared decision-making and give an impetus to modifycharacteristics to improve outcomes.
Further work is required tosee if reducing BMI reverses our observations. This study wouldideally be undertaken as a cohort study, as an RCT would bepotentially difficult to complete per protocol.