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Patient Recall 6 Weeks After Surgical Consent for Midurethral Sling Using Mesh

McFadden, Brook L.; Constantine, Melissa L.; Hammil, Sarah L.; Tarr, Megan E.; Abed, Husam T.; Kenton, Kimberly S.; Sung, Vivian W.; Rogers, Rebecca G.

Obstetrical & Gynecological Survey: November 2013 - Volume 68 - Issue 11 - p 733–735
doi: 10.1097/01.ogx.0000435766.75445.16
Gynecology: Urogynecology

Specific risks of midurethral sling (MUS) surgery associated with the use of a permanently implanted mesh include mesh erosion, pain from mesh placement, and mesh shrinkage. During surgical consent, it is expected that providers explain benefits and disclose postoperative risks and complications associated with the use of transvaginally placed mesh. Moreover, patients should understand that mesh is a permanent implant.

The aim of this study was to investigate patient recall of risks, benefits, alternatives, and other surgical descriptors discussed during consent for MUS surgery immediately after consent and 6 weeks after surgery. A second aim was to determine whether women recalled specific risks associated with the placement of mesh at the 6-week follow-up. Surgeons counseled each patient before MUS surgery and obtained consent in their usual fashion. Immediately after surgical consent and at the 6 weeks’ follow-up, women completed a checklist of risks, benefits, alternatives, and other descriptors of surgery discussed during consent. All consent sessions were audio recorded for verification of the consent discussion. At 6 weeks, patients also completed the Decision Regret Scale for Pelvic Floor Disorders (DRS-PFD). Recall of specific risks, benefits, alternatives, and other descriptors of surgery were correlated with DRS-PFD scores.

Eighty-nine percent of women (n = 63) who underwent MUS surgery completed the checklists immediately after consent and 6 weeks after surgery. Recall of benefits, alternatives, and descriptors of surgery did not change at 6 weeks. However, recall of surgical risk assessed with the checklist and verified by the audio files deteriorated from 92% immediately after consent to 72% at 6 weeks (P < 0.001). From immediately after consent to 6 weeks postoperatively, recall of the risks for mesh erosion declined from 91% to 64% (P < 0.001), and recall that mesh was implanted during surgery declined from 98 to 84 % (P = 0.01). Poorer recall of surgical risks and complications at 6 weeks’ follow-up was correlated with higher DRS-PFD scores (r = 0.31, P = 0.02).

These data show that women’s recall of risks following surgical consent had deteriorated at 6 weeks postoperatively. Specifically, women forgot that a permanent mesh was placed or that it might erode. Further studies are needed to elucidate the details of the surgical consent process and to develop interventions that promote patient recall of long-term surgical risks.

Division of Urogynecology, University of New Mexico Health Sciences Center, Albuquerque, NM (B.L.M., S.L.H., R.G.R.); Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI (M.L.C.); Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL (M.E.T., K.S.K.); Division of Urogynecology, Henry Ford Health System, Detroit, MI (H.T.A.); and Division of Urogynecology & Reconstructive Pelvic Surgery, Warren Alpert Medical School, Brown University, Providence, RI (V.W.S.)

© 2013 by Lippincott Williams & Wilkins.