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Войти в исследования European journal of obstetrics, gynecology, and reproductive biology · 2026
Are consultant-led OASI repairs superior? A retrospective analysis of outcomes compared to non-consultant doctors.
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Galvin Daniel, Rotem Reut, McCormack Kate, O'Sullivan Orfhlaith E, Hayes-Ryan Deirdre
Аннотация
INTRODUCTION: Obstetric Anal Sphincter Injuries (OASI) are severe complications of vaginal delivery, carrying potential disabling consequences. Repairs may be performed by obstetricians and gynaecologists of varying seniority grades. However, the impact of the practitioner's level of expertise on patient outcomes remains unclear. The objective was to compare the demographics, risk profiles, anatomical outcomes, and functional outcomes between women whose OASI repairs were performed by consultants versus resident doctors.
MATERIALS AND METHODS: A retrospective study, conducted at Cork University Maternity Hospital (CUMH) using electronic medical records. Women who did not attend 6 month follow-up or those who had repairs outside CUMH were excluded. Participants were categorized into two groups: those whose repairs were conducted by consultants and those by resident doctors. The primary outcome was a composite adverse outcome six months post-delivery, including resting pressure ≤ 40 mmHg, squeezing pressure ≤ 100 mmHg, and defects in the anal sphincters.
RESULTS: Of the 347 women studied, 288 (83.0 %) had repairs performed by residents, and 59 (17.0 %) by consultants. Private care was significantly more common among consultant-repaired cases (50.8 % vs. 0.3 %, p < 0.001). There were more 3B tears in the resident group (51.4 % vs. 32.2 %, p = 0.007), while consultants handled more complex cases like grade 4 tears (13.6 % vs. 1.7 %, p < 0.001) and buttonhole injuries (3.4 % vs. 0 %, p < 0.029). No significant differences were noted in blood loss, wound infections, or OASI clinic attendance. Functional outcomes, including manometry results, were comparable among groups, with no significant difference in anatomical sphincter defects or composite adverse outcomes.
CONCLUSION: Short-term anatomical and functional outcomes did not significantly differ between repairs performed by consultants and residents. Consultants were more likely to operate on complex cases and private patients. These findings provide reassurance regarding the quality of OASI training and supervision in Ireland.
MATERIALS AND METHODS: A retrospective study, conducted at Cork University Maternity Hospital (CUMH) using electronic medical records. Women who did not attend 6 month follow-up or those who had repairs outside CUMH were excluded. Participants were categorized into two groups: those whose repairs were conducted by consultants and those by resident doctors. The primary outcome was a composite adverse outcome six months post-delivery, including resting pressure ≤ 40 mmHg, squeezing pressure ≤ 100 mmHg, and defects in the anal sphincters.
RESULTS: Of the 347 women studied, 288 (83.0 %) had repairs performed by residents, and 59 (17.0 %) by consultants. Private care was significantly more common among consultant-repaired cases (50.8 % vs. 0.3 %, p < 0.001). There were more 3B tears in the resident group (51.4 % vs. 32.2 %, p = 0.007), while consultants handled more complex cases like grade 4 tears (13.6 % vs. 1.7 %, p < 0.001) and buttonhole injuries (3.4 % vs. 0 %, p < 0.029). No significant differences were noted in blood loss, wound infections, or OASI clinic attendance. Functional outcomes, including manometry results, were comparable among groups, with no significant difference in anatomical sphincter defects or composite adverse outcomes.
CONCLUSION: Short-term anatomical and functional outcomes did not significantly differ between repairs performed by consultants and residents. Consultants were more likely to operate on complex cases and private patients. These findings provide reassurance regarding the quality of OASI training and supervision in Ireland.