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Women's Continence & Pelvic Health
The Women's Continence and Pelvic Health Center at Cedars-Sinai Medical Center is a multidisciplinary care team including specialists from urogynecology, urology, colorectal surgery, gynecology, and gastroenterology. Our goal is to provide comprehensive diagnostic and treatment services for women who suffer from disorders associated with the female pelvic floor, including:
- Urinary incontinence
- Urinary frequency and urgency
- Pelvic organ prolapse
- Rectal prolapse
- Difficulty in bladder or bowel emptying
- Fecal incontinence
- Painful bladder syndrome
- Recurrent urinary tract infections
Surgical treatments performed for some of the conditions above include:
- Suburethral slings
- Vaginal vault suspension and enterocele repair
- Hysterectomy (when indicated)
- Cystocele or rectocele repair
- Insertion of the interstim sacral nerve implant
- Injection of periurethral bulking agents
- Anal sphincter repair
- Colon resection (when indicated)
These operations may be done transvaginally or transrectally, laparoscopically or with an incision. Surgeons at the Cedars-Sinai Center for Women's Continence and Pelvic Health choose the least invasive option that is safe and appropriate for the patient.
Measuring the Quality of Care at the Cedars-Sinai Center for Women's Continence and Pelvic Health
At the Cedars-Sinai Center for Women's Continence and Pelvic Health, a variety of factors are monitored to measure the quality of care available to patients including:
- Board certification. To be board certified, the physician has been subject to both written and oral examinations that ensure that his or her breadth of knowledge and reasoning skills are on par with other physicians in each field of specialization. All members of the Cedars-Sinai Center for Women's Continence and Pelvic Health are board certified.
- Total volumes of procedures. Studies Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e. lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes.1,2 In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons.3
|Vaginal vault suspension||17||18||26|
- Comparing Outpatient and Inpatient Suburethral Sling Rates. As detailed in the chart below, Cedars-Sinai's CWCPH physicians perform outpatient suburethral slings at a far greater rate than the UHC average, which eliminates inpatient hospital admission and helps patients get back to their lives sooner.
|Percent Outpatient vs Inpatient||UHC Average*||2011||2012||2013|
- Average length of stays (ALOS). This refers to the average number of days a patient stays at Cedars-Sinai Medical Center after being admitted. The goal is to ensure that all patients are appropriately treated in the hospital for their respective conditions and are not hospitalized longer than they should be. Suburethral sling procedures and vaginal vault suspension are often done in conjunction with other surgeries such as bladder suspension, rectocele repair and hysterectomy when indicated, lengthening the hospital stay. As detailed in the chart below, in-patient suburethral slings and vaginal vault suspensions performed by Cedars-Sinai’s CWCPH physicians result in a consistently shorter length of stay than the UHC average.
|Average Length of Stay||UHC Average*||2011||2012||2013|
|Suburethral sling||3.63 days||3.22 days||3.96 days||4.15 days|
|Vaginal vault suspension||2.04 days||1.53 days||1.76 days||1.40 days|
*The national average data is derived from the University HealthSystem Consortium (UHC) Clinical Data Base/Resource Manager. UHC is UHC is an alliance of 120 academic medical centers and 301 of their affiliated hospitals representing the nation's leading academic medical centers. Most of these facilities participate in the Clinical Data Base/Resource Manager. The UHC average reflects all patients, excluding LOS outliers, discharged January 1 - December 31, 2013. The data was accessed on May 14, 2014.
1Bach PB, Ann Intern Med 2009; 150:729-30
2Greene FL, Ann Surg Oncol 2007; 15:14-15
3Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08