Gaining the patient perspective on pelvic floor disorders’ surgical adverse events

Abstract

BACKGROUND: The Institute for Healthcare Improvement defines an adverse event as an unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment, or hospitalization or that results in death. The majority of research has focused on adverse events from the provider's perspective. OBJECTIVE: The objective of this qualitative study was to describe patient perceptions on adverse events following surgery for pelvic floor disorders. STUDY DESIGN: Women representing the following 3 separate surgical populations participated in focus groups: (1) preoperative (women <12 weeks prior to surgery); (2) short-term postoperative (women up to 12 weeks after surgery); and (3) long-term postoperative (women 1e5 years after surgery). Deidentified transcripts of audio recordings were coded and analyzed with NVivo 10 software to identify themes, concepts, and adverse events. Women were asked to rank patient-identified and surgeon-identified adverse events in order of perceived severity. RESULTS: Eighty-one women participated in 12 focus groups. Group demographics were similar between groups, and all groups shared similar perspectives regarding surgical expectations. Women commonly reported an unclear understanding of their surgery and categorized adverse events such as incontinence, constipation, nocturia, and lack of improvement in sexual function as very severe, ranking these comparably with intensive care unit admissions or other major surgical complications. Women also expressed a sense of personal failure and shame if symptoms recurred. CONCLUSION: Women consider functional outcomes such as incontinence, sexual dysfunction, and recurrence of symptoms as severe adverse events and rate them as similar in severity to intensive care unit admissions and death.

Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound

“…These symptoms have a wide-ranging impact on the quality of life of women, ranging from mild discomfort to paralysis and even severe functional impairment. [ 16 ] Pelvic floor ultrasound can perform imaging evaluation of female pelvic floor function to prevent and reduce the occurrence of early FPFD. At the same time, it can evaluate the pelvic floor rehabilitation effect, guide clinical early pelvic floor muscle training to improve the pelvic floor muscle strength.…”

How Women Perceive Severity of Complications after Pelvic Floor Repair?

“…Conversely, if the planned surgery was not performed, even in the absence of complications, the women considered it as serious. In another qualitative study, women interviewed preoperatively expressed the need to "get back to normal" within the time period specified by their surgeon [13]; in the postoperative group, women categorized symptoms such as incontinence or constipation, or lack of improvement in sexual function as "very severe". As in our study, women ranked these functional disorders comparably to major surgical complications.…”

“…Our findings may have been different if the women had been interviewed before their surgery. However, the study by Dunivan et al reported that women in the preoperative groups shared similar perspectives regarding surgical expectations [13]. The vignettes were presented in the same random order for all women, and several women commented that they became more and more alarmed as they completed the questionnaire and stopped before the end of the survey.…”

AUGS-PERFORM: A New Patient-Reported Outcome Measure to Assess Quality of Prolapse Care

“…previously published conceptual framework for prolapse derived from patient focus groups. [7][8][9] An expert group consisting of 3 urogynecologists (VS, NS, MO) and one health measurement expert (KW) reviewed the initial set of 10 candidate domains derived from the previously published conceptual framework for prolapse (Fig. 2 and Fig.…”