The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

Objective:

To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons.

Methods:

Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups.

Results:

More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures.

Conclusion:

Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology.

Level of evidence:

Level IV

The General Health Questionnaire: a psychometric analysis using latent trait theory

This study examines the Likert-style successive integer scoring of Goldberg's (1972, 1978) General Health Questionnaire (GHQ) with a psychometric model in which the thresholds between successive categories within each item can be estimated. The model is particularly appropriate because the scoring of the successive categories, which are not named in the same way across items, by successive integers has received substantial discussion in the literature. Results from 1967 teachers in Western Australia who completed the 30-item form of the GHQ show that the items conform reasonably well to the model at a general or macro-level of analysis. In particular, the original ordering of categories is supported. However, as expected, there are systematic differences between distances among threshold within items and systematic differences among thresholds between items. The differences between positively and negatively orientated items confirm a suggestion in the literature that these two classes of items form sufficiently different scales so that they could be treated as separate, though reasonably correlated, scales.