Obliterative Surgery for the Treatment of Pelvic Organ Prolapse
| Autor: | Michelle M. Takase-Sanchez, Michael Heit, Douglass S. Hale, Hannah M. Brooks |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Pessary
medicine.medical_specialty Cross-sectional study Urology Decision Making Emotions MEDLINE Pelvic Organ Prolapse Gynecologic Surgical Procedures Patient satisfaction Surveys and Questionnaires Bayesian multivariate linear regression Humans Medicine Postoperative Period Aged Reproductive health Aged 80 and over business.industry General surgery Confounding Obstetrics and Gynecology Regret General Medicine Surgery Cross-Sectional Studies Treatment Outcome Patient Satisfaction Vagina Female business |
| Zdroj: | Female Pelvic Medicine & Reconstructive Surgery. 21:325-331 |
| ISSN: | 2151-8378 |
| DOI: | 10.1097/spv.0000000000000198 |
| Popis: | OBJECTIVES To identify patient-reported reasons for selecting obliterative surgery for the purpose of predicting decision regret and satisfaction. METHODS We created a deidentified database of patients who underwent an obliterative procedure for prolapse from 2006 to 2013. Patients were excluded if they declined study participation, were deceased, or had dementia. Participants completed a survey regarding reasons for selecting obliterative surgery and a modified version of validated questionnaires on decision regret (Decision Regret Scale-Pelvic Floor Disorder) and satisfaction (Satisfaction with Decision Scale-Pelvic Floor Disorder). Parsimonious multivariate linear regression models were constructed to determine if any of the reasons given for choosing obliterative surgery were independent predictors of decision regret and satisfaction after controlling for significant sociodemographic, clinical, and surgical outcome data identified by bivariate analysis. RESULTS Seventy-seven women completed the surveys. "To follow my doctor's recommendations" and "no longer sexually active," and/or "did not plan to be" as reasons for selecting obliterative surgery made the most difference; however, these reasons were not identified as independent predictors of decision regret or satisfaction after controlling for confounders. The regret linear regression models identified preoperative sexual activity rather than the patient-reported reason "no longer sexually active and/or did not plan to be," as the only independent predictor of more decision regret after obliterative surgery (B coefficient 1.68, P < 0.01). The satisfaction linear regression models identified reoperation for any reason as an independent predictor of lower satisfaction (β, -0.24; P = 0.04) and the patient-reported reason for choosing obliterative surgery "not interested in pessary" as a predictor of higher satisfaction (β, 0.30, P = 0.01). CONCLUSIONS This study advances our knowledge about the obliterative surgical decision making process. Behavioral and educational interventions directed at improving patient and physician communications concerning the dynamics of sexual health issues in an aging population will likely decrease regret when obliterative surgery is chosen. Minimizing reoperation after obliterative surgery through increased experience, knowledge, and improved surgical skills and patient validation when pessary is declined will likely improve satisfaction when obliterative surgery is chosen. |
| Databáze: | OpenAIRE |
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