The Patient Perspective on Adverse Surgical Events After Pelvic Floor Surgery

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.

Duke Scholars

Author Cindy Louise Amundsen Obstetrics and Gynecology, Urogynecology