[Validity of the registration and reporting of vaginal prolapse surgery]. / Validitet af kodning og indberetning ved vaginal prolapskirurgi.

INTRODUCTION: To validate the coding and local registration of vaginal prolapse surgery in 1996-1998, and reporting of such data to the Danish National Patient registry (LPR). MATERIAL AND METHODS: Comparison of different sets of data from the local data base (GS) and LPR, and retrospective study of 296 patient files. RESULTS: The concordance between two GS-data sets was 96.4%, and 0-100% between different LPR-data sets. The validity of reporting of data from GS to LPR was 96.2% on the level of patient ID (cpr), and 99.3% concerning length of hospital stay. If a procedure was registered as a vaginal prolapse procedure the validity of this being true was 93.6%. 18 non-prolapse procedures were registered as vaginal procedures. The registration was incomplete in 12.5% due to typing or hearing errors or missing codes. The coding was misleading in 11.8%, due to lack of consensus on coding. 86.6% of errors were passed through from the patient file to GS and LPR. Through simple guidelines misleading use of combination of codes was reduced from 7% to 0.5%. CONCLUSION: The validity of the two sets of GS data, and the reporting from GS to LPR of vaginal surgical procedures is satisfactory on the cpr-level. However, the validity of such register data is affected by the risk of errors when drawing such data, and by coding errors. The main problems are lack of consensus on which codes to use, and that codes for very different procedures are very much alike. To improve the quality and usefulness of register data in monitoring vaginal prolapse procedures consensus on coding is desirable. Different methods to increase the quality of coding are discussed.

The Danish anal sphincter rupture questionnaire: validity and reliability.

OBJECTIVE: To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. SETTING AND BACKGROUND: Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. METHOD: The original questionnaire was revised and a pilot test was performed among health care personnel, followed by an expert panel discussion. Ten women were interviewed about their understanding and attitude toward answering the questionnaire and it was pre-tested on 52 women with ASR. The questionnaire was revised five times during the validation process. The final version was test-retested among 20 women with ASR. RESULTS: The questionnaire revealed typical problems after ASR. The length, use of language, and the way the questionnaire was constructed, was deemed appropriate. The reliability test showed good to very good correlation (Kappa values from 0.733 to 0.923) in all main questions but one. Two questions needed further explanation. Seven women made minor errors. CONCLUSION: The validated Danish questionnaire has a good construct, content and face validity. It is a well accepted, reliable, simple and clinically relevant screening tool. It reveals physical problems including sexual problems, impact on quality of life and need for treatment among women 6-8 months after ASR.

Short convalescence after vaginal prolapse surgery.

OBJECTIVE: Retrospectively to describe the recommended convalescence according to patients who had undergone vaginal prolapse surgery in 1996-98, and prospectively to describe the need for and limiting factors for convalescence after vaginal prolapse surgery in 1999-2000 at a Danish University Hospital. METHODS: The retrospective study included a validated, postal, questionnaire and review of patient files. In the prospective study, we followed consecutive women after vaginal surgery in a fast-track setting using a multimodal rehabilitation model with well-defined recommendations for the convalescence period. RESULTS: In the retrospective study, 188 women (79%) with a median age of 66 years (range, 30-88) answered the questionnaire. They had been recommended a convalescence of median 6 weeks (range, 1-12) for most activities. The subjective recurrence rate was 22% within median 6 months (range, 0-24) after first-time prolapse surgery. In the prospective study, there were 41 consecutive women with a median age of 69 years (range, 44-88). Convalescence was median <1 week for most non-strenuous activities, <2 weeks for light work and <4 weeks for sexual intercourse, sports and work with lifts exceeding 10 kg. Limiting factors were fatigue and pain. The 1-year subjective recurrence rate was 17%. CONCLUSION: Traditionally, recommended convalescence has been median 6 weeks after vaginal prolapse surgery. Convalescence has been shortened to 1-3 weeks with a multimodal rehabilitation model with revised, non-restrictive recommendations. Further studies are necessary to evaluate the impact of different convalescence recommendations on the recurrence of prolapse.

Fast track vaginal surgery.

OBJECTIVE: Our aim was to describe the need for postoperative hospitalization after vaginal surgery for utero-vaginal prolapse with well-defined charts for postoperative care. DESIGN: A prospective, descriptive study. Consecutive women admitted for first-time vaginal surgery for utero-vaginal prolapse at a public university hospital in Copenhagen, Denmark, underwent surgery and postoperative care in a fast track setting from September 15, 1999 to June 15 2000. METHODS: A multimodal rehabilitation model with emphasis on information, standardized general anesthesia, reduced surgical distress, optimized pain-relief, early oral nutrition and ambulation, minimal use of indwelling catheter and vaginal packing. OUTCOME MEASURES: Postoperative hospital stay, complications, re-admission, success rate, patients' satisfaction and acceptability. RESULTS: Forty-one women with a median age of 69 years (range, 44-88 years) were included. All underwent anterior and/or posterior vaginal repair. Nineteen (46.3%) underwent vaginal hysterectomy, and eight (19.5%) underwent the Manchester procedure. Postoperative hospital stay was median 24 hr. Only three (7.3%) were discharged later than 48 hr. No re-admissions occurred. The most frequent complications were urinary retention exceeding 450 ml, and urinary tract infection (12.2%, and 9.8%, respectively). Short-term success rate was 97.6%. Patients' satisfaction rates were 85.4-95.1%. The median score of acceptability was 10 on a 0-10 points scale. CONCLUSION: The need for postoperative hospitalization was median 24 hr after vaginal surgery in a fast track setting, independently of the complexity of the procedure performed. Short-term success rate, satisfaction rates, and acceptability were all excellent. Follow up has been established to evaluate long-term success rates and recurrence.