56: Comparative analysis of attitude, knowledge, and recollection of preoperative counseling regarding pelvic mesh among women with or without a mesh-related complication

Abstract

To retrospectively compare the attitude, knowledge, and recollection of preoperative counseling regarding mesh for pelvic organ (POP) prolapse and/or urinary incontinence (UI) among women with or without a mesh-related complication (MC). We conducted a case-control study among women who had prior implantation of synthetic, non-absorbable mesh for POP and/or UI). Eligible women with or without a MC who were at least 3 months from their mesh surgery were identified by chart review. They completed a written survey which queried the type of mesh implanted, indication for surgery, and, if relevant, and the nature of mesh-related complication(s). They rated (on a 5 point Likert scale) their likelihood of having the same mesh surgery and selecting mesh versus non-mesh surgery if they could choose again. We asked what the physician could have done to improve perioperative care. The primary outcome was the proportion of women who recalled being counseled preoperatively about the risk of mesh exposure. One hundred three eligible women were approached and 96 were included in the final analysis (n=50 MC; n=46 no MC). Most correctly recalled the route of mesh placement (67/91, 74%). Women who had a MC were younger (54.2 ± 12.9 yrs MC vs 59.3 ± 12.1 yrs no MC, p=0.04); were further from the time of their mesh implantation (median 75 mo [IQR 30-116] MC vs median 12 mo [IQR 6-66] no MC, p=0.05); and were more likely to have had an UI indication [26/50 (52%) MC vs 14/46 (30%) no MC, p=0.01]. There were no other significant differences between groups in patient characteristics or type of mesh implanted. Adjusting for time since mesh implantation and age, women with MC were significantly less likely to recall being counseled about the possibility of any MC [19/50 (38%) MC vs 32/44 (73%) no MC, aOR 0.27, 95% CI 0.09–0.77, p=0.01]. The proportion of women who recalled being counseled about mesh exposure was similar between the groups [12/29 (24%) MC vs 17/29 (37%), p=0.19]. On Likert scales, women without a MC were more likely to report they would undergo the same surgery (median 3 [IQR 1–4] MC vs median 5 [IQR 3–5] no MC, p<0.01) and more likely to want mesh vs non-mesh surgery if they could choose again (median 1 [IQR 1–3] MC vs 5 [IQR 3–5] no MC, p<0.01). Regarding what the physician could have done to improve perioperative care, more women in the MC group recommended improved preoperative counseling about potential risks and benefits [27/50 (54%) MC vs 6/46 (13%) no MC, p<0.01], closer postoperative follow-up [14/50 (28%) MC vs 2/46 (4%) no MC, p<0.01], and more information on postoperative expectations [15/50 (30%) MC vs 4/46 (9%) no MC, p=0.01]. Women who experience a MC are less likely to recall being counseled on mesh risks than women without an MC and report more needs regarding preoperative counseling.