Abstract
Purpose of Review
To review the present literature describing the patient experience of adverse events (AEs) following pelvic reconstructive surgery (PRS).
Recent Findings
Patients’ perceived importance of AEs changes over the short-, medium-, and long-term postoperative period, with functional outcomes gaining dominance over time. Surgical failure is consistently the principal severe AE perceived by patients both pre- and postoperatively. New or worsening adverse bowel or urinary symptoms are also consistently rated as a severe complication. Long-term AEs can be broadly categorized into psychological, functional, and relational AEs that impact patients’ emotions surrounding treatment, physical, and physiological function, as well as social network and intimate relationships. Long-term AEs that diminish function or quality of life are perceived by patients as being just as severe as AEs that surgeons typically view as “very severe.”
Summary
As patients’ surgical expectations and goals may not always be in agreement with what a given PRS can consistently resolve, especially as it relates to associated urinary or bowel symptoms, surgeons should elicit and address patients’ expectations and goals of treatment preoperatively.
Patients tend to view surgical failure and recurrence as personal failures, and thus, surgeons should have honest preoperative discussions of recurrence risk following PRS and the reasons for recurrence, proactively shifting blame away from the patient herself. Finally, by emphasizing PFDs as being chronic conditions rather than episodic problems that can be surgically “fixed,” the surgeon can reframe the relationship with the patient to being one of optimizing pelvic floor health throughout her lifetime.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Gutman RE, Nygaard IE, Ye W, Rahn DD, Barber MD, Zyczynski HM, et al. The pelvic floor complication scale: a new instrument for reconstructive pelvic surgery. Am J Obstet Gynecol. 2013;208(1):81.e1-9.
Gillingham A, Collins SA, Kenton K, Bretschneider CE, Lewicky-Gaupp C, Mueller MG, et al. The Influence of Patients’ Goals on Surgical Satisfaction. Female Pelvic Med Reconstr Surg. 2021;27(3):170–4. (Study providing qualitative data supporting the association between the attainment of patients’ preoperative goals and postoperative satisfaction and regret following PRS.)
Mamik MM, Rogers RG, Qualls CR, Komesu YM. Goal attainment after treatment in patients with symptomatic pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):488.e1-5.
Elkadry EA, Kenton KS, FitzGerald MP, Shott S, Brubaker L. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189(6):1551–7 (discussion 1557-1558).
Lawndy SSS, Withagen MI, Kluivers KB, Vierhout ME. Between hope and fear: patient’s expectations prior to pelvic organ prolapse surgery. Int Urogynecol J. 2011;22(9):1159–63.
Mallett VT, Brubaker L, Stoddard AM, Borello-France D, Tennstedt S, Hall L, et al. The expectations of patients who undergo surgery for stress incontinence. Am J Obstet Gynecol. 2008;198(3):308.e1-6.
Foster RT, Barber MD, Parasio MFR, Walters MD, Weidner AC, Amundsen CL. A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse. Am J Obstet Gynecol. 2007;197(1):82.e1-4.
Miedel A, Tegerstedt G, Maehle-Schmidt M, Nyrén O, Hammarström M. Symptoms and pelvic support defects in specific compartments. Obstet Gynecol. 2008;112(4):851–8.
Sung VW, Wohlrab KJ, Madsen A, Raker C. Patient-reported goal attainment and comprehensive functioning outcomes after surgery compared with pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2016;215(5):659.e1-659.e7.
Dunivan GC, McGuire BL, Rishel Brakey HA, Komesu YM, Rogers RG, Sussman AL. A longitudinal qualitative evaluation of patient perspectives of adverse events after pelvic reconstructive surgery. Int Urogynecol J. 2019;30(12):2023–8.(Longitudinal qualitative study of the evolution of patients’ perceptions of adverse events over time following PRS.)
Dunivan GC, Sussman AL, Jelovsek JE, Sung V, Andy UU, Ballard A, et al. Gaining the patient perspective on pelvic floor disorders’ surgical adverse events. Am J Obstet Gynecol. 2019;220(2):185.e1-185.e10. (Qualitative study of patients’ perspectives of adverse events following PRS. Establishes a conceptual framework of the relative importance of surgical AEs following PRS, including short, intermediate and long-term AEs.)
Houwert RM, van Munster DN, Roovers JPWR, Venema PL, Dijkgraaf MGW, Bruinse HW, et al. Perspectives by patients and physicians on outcomes of mid-urethral sling surgery. Int Urogynecol J. 2010;21(4):415–21.
Fitzgerald J, Siddique M, Miranne JM, Saunders P, Gutman R. Development of a patient-centered pelvic floor complication scale. Female Pelvic Med Reconstr Surg. 2020;26(4):244–8. (Qualitative study of patients’ perceptions of postoperative complication which provides evidence of patients’ perception of functional outcomes such as new or worsening preexisting constipation as a severe outcome, as well as the emphasis on the transparency of preoperative counseling.)
Ghetti C, Skoczylas LC, Oliphant SS, Nikolajski C, Lowder JL. The emotional burden of pelvic organ prolapse in women seeking treatment: a qualitative study. Female Pelvic Med Reconstr Surg. 2015;21(6):332–8.
Sung VW, Rogers RG, Barber MD, Clark MA. Conceptual framework for patient-important treatment outcomes for pelvic organ prolapse. Neurourol Urodyn. 2014;33(4):414–9.
Siddiqui NY, Gregory WT, Handa VL, DeLancey JOL, Richter HE, Moalli P, et al. American urogynecologic society prolapse consensus conference summary report. Female Pelvic Med Reconstr Surg. 2018;24(4):260–3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Patient Engagement, Education, and Literacy for Pelvic Floor Disorders
Rights and permissions
About this article
Cite this article
O’Shea, M., Amundsen, C.L. The Patient Perspective on Adverse Surgical Events After Pelvic Floor Surgery. Curr Bladder Dysfunct Rep 17, 143–148 (2022). https://doi.org/10.1007/s11884-022-00646-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-022-00646-7