Patient Satisfaction In Women Research Articles

Effect of easy cupping combined with pelvic floor electrical stimulation and Kegel exercise and pelvic floor muscle surface electromyography on symptoms improvement in women with stress urinary incontinence.

This study aimed to evaluate the effectiveness of easy cupping combined with pelvic floor electrical stimulation and Kegel exercises in treating female patients with stress urinary incontinence (SUI). Ninety SUI patients were randomly assigned to two groups: the control group (pelvic floor electrical stimulation + Kegel exercises) and the experimental group (easy cupping + pelvic floor electrical stimulation + Kegel exercises). Outcomes assessed included pelvic floor muscle strength, urinary incontinence, urinary leakage, pelvic floor muscle surface electromyography, adverse effects, and patient satisfaction before and after treatment. Results showed significant improvements in pelvic floor muscle strength, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICI-Q-SF) scores, and urinary leakage in both groups, with the experimental group showing greater improvements (P < 0.05). The experimental group also had higher pelvic floor muscle potential values and a greater total effective rate (P < 0.05). No significant differences in adverse effects were noted between groups, and patient satisfaction was higher in the experimental group (P < 0.05). In conclusion, the combination of easy cupping with pelvic floor electrical stimulation and Kegel exercises effectively enhances pelvic floor muscle strength, reduces urinary leakage, and improves patient satisfaction in women with stress urinary incontinence.

Care seeking during pregnancy: testing the assumptions behind service delivery redesign for maternal and newborn health in rural Kenya.

A health systems reform known as Service Delivery Redesign (SDR) for maternal and newborn health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions that underpin the SDR policy's theory of change. We analyse data on place of delivery, travel time and distance, out-of-pocket spending, and self-reported quality of care for 19 127 women prospectively enrolled during antenatal care (ANC) and surveyed two times after their delivery. We analyze changes in womens' delivery location preferences in recent years in Kakamega, and over the course of their most recent pregnancy. We also evaluate travel time, out-of-pocket expenditures and patient satisfaction for women who deliver in public hospitals vs primary health centres. We find substantial changes in delivery location at the population level over time and for individual women over the course of pregnancy. Facility delivery has increased from 50.4% in 2010 to 89.5% in 2019; 70% of respondents deliver at a different facility than their reported intention at ANC. Out-of-pocket delivery expenditures are on average 1351 Kenyan shillings (Ksh) in hospitals compared to 964 Ksh in PHC (primary health care)s (P < 0.01). Transport expenditures are 337 Ksh for PHC level deliveries vs 422 Ksh for hospitals (P < 0.01). Self-reported average travel time is 51 min (PHC delivery) vs 47 min (hospital delivery) (P = 0.78). The average distance to a delivery location is 15.1 km for PHC deliveries vs 15.2 km for hospitals (P = 0.99). There were no differences in overall patient-reported quality scores, while some subcomponents of quality favoured hospitals. These findings support several key assumptions of the SDR theory of change in Kakamega County, while also highlighting important challenges that should be addressed to increase the likelihood of successful implementation.

Influence of humanistic care on negative emotions, nursing quality, and patient satisfaction in outpatient gynecological surgery.

To explore the impact of humanistic care on negative emotions, nursing quality and patient satisfaction among women undergoing outpatient gynecological surgery. This retrospective study involved 108 patients who underwent outpatient gynecological surgery at the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine between August 2022 and August 2023. The patients were divided into two groups: 51 patients received routine care (control group) and 57 received humanistic care (experimental group). Data collected included vital signs (heart rate [HR] and systolic/diastolic blood pressure [SBP/DBP]), pain levels (Visual Analogue Scale [VAS] scores at 12 and 24 hours postoperative), negative emotions (Self-rating Anxiety/Depression Scale [SAS/SDS]), comfort (Kolcaba's General Comfort Questionnaire [GCQ]), sexual functioning (Brief Index of Sexual Functioning for Women), nursing quality (errors, defects, and complaints) and patient satisfaction. Intraoperative SBP, DBP, along with HR, were significantly lower in the experimental group compared to the control group (all P<0.05). Postoperative pain levels at both 12 and 24 hours were also significantly reduced in the experimental group (both P<0.01). Furthermore, the experimental group demonstrated significant reductions in SAS and SDS scores and higher GCQ scores across physical, psychospiritual, environmental, and sociocultural dimensions (all P<0.05). There were no significant differences between the groups in terms of sexual desire, activity, and satisfaction (all P>0.05). Nursing quality was significantly better (P=0.029) and patient satisfaction with nursing care was higher (P=0.015) in the experimental group. Humanistic care significantly reduces negative emotions and enhances comfort, nursing quality, and patient satisfaction in women undergoing outpatient gynecological surgery. This approach does not affect sexual functioning indicators but offers substantial improvements in overall patient care and outcomes. Its high value for clinical promotion underscores its potential as a transformative approach in outpatient gynecological settings.

Modified laparoscopic high uterosacral ligament suspension for treatment of apical prolapse: A feasibility study.

The purpose of this study was to evaluate the feasibility of modified laparoscopic high uterosacral ligament suspension (LHUS) in women with apical prolapse who require uterine preservation. This retrospective feasibility study analyzed the demographic characteristics, procedure, and 3-year follow-up data of 23 women who underwent modified LHUS at our institution. Outcome measures included clinical and anatomical cure. Patient satisfaction was measured by the Patient Global Impression of Improvement (PGI-I). The improvement on quality of life was evaluated by pelvic floor distress inventory-short form 20 (PFDI-20). The operation time was 50 ± 17 min, the blood loss was 100 ml (50-300 ml), and the postoperative hospital stay was 3.5 days (3-6 days). At a median follow-up time of 4.3 years (3-6 years), the clinical cure rate was 91.6% and the anatomical cure rate was 87.0%. The values of Aa, Ba, C, and D points were significantly higher than those observed before operation (p < 0.05). According to PGI-I, 20 patients were satisfied, and the overall subjective satisfaction rate was 87%. The scores of PFDI-20 after operation were significantly lower than those recorded before operation (p < 0.05). Modified LHUS has the advantages of short operation time, fast postoperative recovery, low 3-year recurrence rate, and high patient satisfaction in women with apical prolapse who require uterine preservation, which is worthy of clinical promotion.

Patient Satisfaction of the Non-Surgical Lysis Procedure for Clitoral Adhesions in Patients with and without Lichen Sclerosuas

ABSTRACT Introduction Lichen sclerosus (LS) is a chronic, inflammatory skin disorder in the anogenital region typically found in prepubertal or postmenopausal women that causes skin thinning, whitening, wrinkling, itching, and pain. LS is an established risk factor for the development of clitoral adhesions (CA). CA occur when the prepuce adheres to the glans clitoris leading to discomfort, hypersensitivity/hyposensitivity, difficulty reaching orgasm, and chronic vulvodynia. However, CA can also occur in the absence of LS. Two lysis of CA treatment modalities exist - one surgical procedure and one non-surgical, office-based procedure that stretches the preputial tissue open. Previous studies explored LS patient satisfaction with surgical lysis or dorsal-slit surgery but not with the non-surgical approach. The non-surgical office-based procedure has also never been studied in patients without LS. Objective The aim of this study is two-fold: to evaluate patient satisfaction and outcomes of the non-surgical lysis of CA procedure in women with LS and to compare the efficacy of the procedure in patients with and without LS. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using a retrospective chart review. An online survey was sent to these patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results 41 women participated in the study (67% response rate) and 5 had a diagnosis of LS that was optimally treated with high-potent steroids. In terms of procedure satisfaction, there was no significant difference in patient satisfaction (80% vs 83%) or the likelihood of recommending the procedure to a friend who also had CA (80% vs. 94%) among women with and without LS. In regards to improving sexual functioning, there was no significant difference in the procedure's ability to improve sexual arousal (80% vs. 60%), ability to orgasm (80% vs. 62%), and sexual satisfaction (60 vs. 72%) between women with and without LS. Finally, there was no significant difference in reporting the procedure was painful (40% vs. 25%) or the incidence of recurrence of adhesions (40% vs. 51%). Conclusions This study demonstrates high patient satisfaction and improvement in sexual functioning associated with the non-surgical lysis procedure for CA in women with and without LS. CA should not be considered as an adjunct side-effect of LS but as an independent pathology. Physicians should examine the clitoris in women with and without LS in order to determine if a patient has CA. Once diagnosed, the non-surgical lysis procedure has similar efficacy and patient satisfaction in women with and without LS and could be considered as a treatment option for improving sexual function in women. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

Effect of intramuscular midazolam premedication on patient satisfaction in women undergoing general anaesthesia: a randomised control trial

ObjectiveTo determine the effect of premedication with intramuscular midazolam on patient satisfaction in women undergoing general anaesthesia.Trial design, setting and participantsDouble-blind, parallel randomised control trial at a tertiary care medical...

Patient Satisfaction and Surgical Outcome After Oncoplastic Reconstruction following Radical Lumpectomy Versus Standard Lumpectomy: A Retrospective Cohort Study.

Oncoplastic reconstruction (OR) enables widening of the indications for breast conserving therapy (BCT) and is redefining the limits of breast conservation. We examined the outcome and satisfaction of patients undergoing OR after radical lumpectomy (excision of more than 25% of the breast volume) and compared it to the outcome of women undergoing OR after standard lumpectomy. A retrospective, cohort study, including all patients undergoing OR after BCT between 2009 and 2018, was conducted. The ratio of volume of excision to breast volume was calculated using imaging studies. The study group included women that had more than 25% of their breast volume removed. The remainder formed the control group. Demographic characteristics, oncological treatment, and operation properties were collected. We compared post-operative complications, margin status and need for further surgery, as well as patient satisfaction, evaluated using the BREAST-Q Questionnaire. One hundred and fifty women were included, of whom 24 (16%) comprised the study group with a mean breast volume reduction of 39%, while the remainder (mean volume reduction 8%) served as controls. Patient, tumor characteristics and treatment were comparable. There was a non-significant higher proportion of women in the radical group that underwent a second operation due to complications or positive margins [4/24 (16.7%) vs. 14/126 (11%), p = 0.4). Physical well-being was similar but satisfaction with breasts and with outcome was slightly lower for the study group. These differences did not reach statistical significance. Surgical outcome and patient satisfaction in women undergoing very extensive breast resections with OR are comparable to standard resections.

Vaginal Colposuspension Using the Uphold Lite Mesh System versus Transvaginal Hysterectomy with Uterosacral Ligament Suspension for Treatment of Apical Prolapse: A Comparative Study

To compare clinical and anatomic outcomes as well as patient satisfaction in women undergoing vaginal colposuspension using the Uphold Lite system (Boston Scientific Corporation, Marlborough, MA) and transvaginal hysterectomy with uterosacral ligament suspension (VUSLS) for the treatment of apical prolapse. Retrospective cohort study. Female pelvic medicine and reconstructive surgery unit at a university-affiliated tertiary medical center. Women with apical prolapse who underwent either vaginal colposuspension using the Uphold Lite system (uterine-preserving as well as after previous hysterectomy) or VUSLS from 2010 to 2019. Excluded were women with 1 month or less of follow-up. None. A total of 164 women were included in the study: 112 women underwent VUSLS, and 52 underwent colposuspension using the Uphold Lite mesh system. Age, body mass index, maximal birth weight, comorbidity rates, and pelvic organ prolapse severity were similar between the groups. The clinical cure rate was similarly high in both groups, with 91.1% in the women who underwent VUSLS and 88.5% in those in the Uphold Lite group (p = .60). No differences were noted between the groups with regard to anatomic cure rate or composite outcome success rate (73.9% vs 76.0%, p = .77 and 70.3% vs 74.0%, p = .63, in the VUSLS and Uphold Lite groups, respectively). An advantage was noted in the VUSLS group with regard to patient satisfaction with 98.1% of the women stating that their condition was very much better (Patient Global Impression of Improvement questionnaire: A) or much better (Patient Global Impression of Improvement questionnaire: B) compared with 83.9% of the women in the Uphold Lite group (p = .023). In an attempt to assess the association between different variables and the composite outcome, a multivariate analysis was performed in which increased body mass index, menopausal status, and increased preoperative genital hiatus were found to decrease composite outcome success. Vaginal colposuspension using the Uphold Lite system and VUSLS for the treatment of apical prolapse have comparable results with high clinical success rates.

New Innovation: Use of Flash Glucose Monitoring for Evaluating Glycaemic Variability, Patient Satisfaction and Clinical Utility in Pregnant Women with Diabetes.

Application of Flash glucose monitoring (FGM) system to evaluate glycaemic variability (GV), patient satisfaction and clinical utility in pregnant women with diabetes. This prospective study was conducted in a tertiary care teaching hospital on 70 pregnant women with diabetes where blood sugar levels were monitored by FGM and self-monitoring of blood glucose (SMBG). FGM generated 19,950 readings versus 1470 readings by SMBG over 3days. Glucose values measured by FGM and SMBG had significant positive correlation (r > 0.89; p < 0.001). Significant difference (p < 0.001) was present between minimum glucose values by FGM (52.49 ± 15.42mg/dl) and SMBG (72.74 ± 18.30mg/dl). FGM (20.9%) was able to pick exact duration of hypoglycaemia, while one-third of this duration was missed by conventional SMBG (14.7%; p < 0.05). Hypoglycaemic episodes were observed in 92.9% women by FGM as compared to 45.7% by SMBG (p < 0.001). No significant difference was observed in maximum glucose level or duration of hyperglycaemia by both methods. FGM identified hyperglycaemia in 74% women vs. 52% by SMBG (p < 0.001). GV calculated by using MODD by FGM was 118.4 ± 52.4mg/dl and by SMBG was 83.2 ± 53.2mg/dl (p < 0.001). 100% women preferred AGP vs. SMBG. This is the first study to evaluate FGM for GV and patient satisfaction in women with GDM. Significant correlation was observed in glucose values by FGM and SMBG. FGM was more sensitive in detecting GV and hypoglycaemic excursions as compared to SMBG. All women preferred FGM over SMBG. Use of FGM gave new insights in clinical management of challenging cases.

A Randomized Controlled Trial to Assess the Use of a Virtual Decisional Aid to Improve Knowledge and Patient Satisfaction in Women Considering Breast Reconstruction Following Mastectomy.

BackgroundThe decisional process of navigating breast reconstruction surgery is very challenging for patients with a breast cancer diagnosis. This study aims to assess the impact of a virtual breast reconstruction decision aid program on the decision-making process of breast cancer patients considering breast reconstruction. MethodsA two-arm, randomized, controlled trial was conducted at the University of Pittsburgh. Patients were blindly assigned to one of two arms: Emmi Decide (Emmi Solutions LLC, Chicago, IL) program prior to traditional consultation (intervention) and traditional consultation alone (control). All patients completed a baseline pre- and post-intervention questionnaire to evaluate knowledge, patient satisfaction, and psychological status. Surgeons' satisfaction and consultation time were also recorded.ResultsA total of 26 patients participated in the study (n=13 in each arm). Patients in the intervention group reported a greater BREAST-Q reconstruction module score (control=47.9±8.2, intervention=56.8±4.2, p=0.0017), lower decisional conflict scale score (control=30.2±11.8, intervention=14.5±8.8, p=0.017), and improved patient knowledge (control=70.8±15.5%, intervention=83.1±13.8%, p=0.018). No difference was noted in consultation time (control=51.0±7.8 min, intervention=47.8±13.7 min, p=0.46) and psychological testing (control=49.7±16.0, intervention=44.6±15.2, p=0.26). However, surgeons reported greater satisfaction with their consultations with interventional group participants (control=3.4±0.7, intervention=4.8±0.4, p=0.000056).ConclusionsThe use of a virtual decisional aid program to assist the decision-making of breast reconstruction patients was shown to significantly benefit both patients and surgeons, by improving patient knowledge and satisfaction without placing an additional psychological burden on them. This supports the notion that this resource is a promising tool that can improve the difficult process of breast reconstruction in the vulnerable population of breast cancer patients.

Bridging the Gap: A Priorities Assessment Tool to Support Shared Decision Making, Maximize Appointment Time, and Increase Patient Satisfaction in Women With Ovarian Cancer.

Women with ovarian cancer identify patient-physician communication as an essential element in determining treatment course and believe a discussion about goals and values should precede treatment decisions. We sought to develop a patient-centered priorities assessment tool for women with ovarian cancer that could streamline communication, enhance treatment discussions, and increase patient satisfaction. We designed a priorities assessment tool using a validated ovarian cancer symptom index (National Comprehensive Cancer Center-Functional Assessment of Cancer Therapy Ovarian Symptom Index-18) combined with an index to assess daily quality-of-life priorities. The tool was distributed to women with ovarian cancer in small focus group settings and online, followed by a postactivity feedback form. In this pilot study, 36 women completed the priorities assessment tool and 35 completed the postactivity feedback form between September 2015 and May 2016. All participants reported that the tool was easy to understand and comprehensive in scope. Twenty-nine participants (82.9%) completed the tool in 10 minutes or less. Most participants (n = 31, 86.1%) were able to stratify their priorities and identify 5 top treatment-related priorities. Participants who indicated that their goals and priorities had changed since diagnosis (n = 25, 69.4%) reported that the tool helped to identify current goals and priorities (22 [88%] of 25 participants) and would help them feel more comfortable participating in shared decision making with their medical team (21 [84%] of 25 participants). A patient-centered priorities assessment tool was easy to complete and viewed as comprehensive and useful in a pilot cohort of women with ovarian cancer. Use of a priorities assessment tool has the potential to enhance communication, promote shared decision making, and improve patient satisfaction.

Assessing the impact of procedure-specific opioid prescribing recommendations on opioid stewardship following pelvic organ prolapse surgery

Nationally, there is increasing concern regarding the volume of opioid medications prescribed postoperatively and the rate of prescription opioid-related adverse events. In evaluation of this, several reports have identified significant variability in postoperative opioid-prescribing patterns, including quantities exceeding patient's needs, especially after minor surgical procedures. However, data regarding patient's postoperative opioids needs following surgery for pelvic organ prolapse are sparse. To design procedure-specific opioid-prescribing recommendations for pelvic organ prolapse surgeries and evaluate their impact on opioid stewardship. We prospectively evaluated opioid-prescribing patterns, patient use, medication refills, and patient satisfaction in women undergoing prolapse surgery (ie, vaginal, abdominal, or robotic) during an 8-month time period. Two cohorts of women, stratified by whether they had surgery before or after implementation of procedure-specific opioid-prescribing recommendations, were evaluated. Postoperative opioid usage (assessed via pill count), medication refills, and satisfaction with pain management after hospital dismissal were evaluated by telephone call 2 weeks after surgery. Postoperative opioid prescribing and use were recorded after conversion to oral morphine equivalents. Overall, 96 women were included, 57 in the initial baseline cohort, and 39 following implementation of the prescribing recommendations. In the initial cohort, 32.8% of the prescribed oral morphine equivalents (3607/11,007 mg) were consumed. Following implementation of the prescribing recommendations, median oral morphine equivalents prescribed decreased from 200 mg oral morphine equivalents (interquartile range 150, 225) to 112.5 mg oral morphine equivalents (interquartile range 22.5, 112.5; P<.0001). The total oral morphine equivalents prescribed decreased by 45% when compared with the volume that would have been prescribed before implementing the recommendations. The amount of leftover opioids per patient significantly decreased as well (P<.0001). Pain medication refills increased after the intervention (18% vs 3.5%; P=.03), whereas satisfaction scores were similar in both cohorts (P=.87). By using procedure-specific opioid prescribing recommendations, we decreased the number of opioids prescribed at hospital dismissal by roughly one half. Decreased opioid prescribing did not adversely impact patient satisfaction.

Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study

BackgroundEpidural analgesia is a popular choice for labour pain relief. Patient satisfaction is an important patient-centric outcome because it can significantly influence both mother and child. However, there is limited evidence in the correlations between clinical determinants and patient satisfaction. We aim to investigate clinical covariates that are associated with low patient satisfaction in parturients receiving labour neuraxial analgesia.MethodsAfter institutional ethics approval was obtained, we conducted a retrospective cohort study using electronic and corresponding hardcopy records from 10,170 parturients receiving neuraxial analgesia between the periods of January 2012 to December 2013 in KK Women’s and Children’s Hospital in Singapore. Demographic, obstetric and anesthetic data were collected. The patient satisfaction scores on the neuraxial labour analgesia was reported by the parturient at 24 to 48 h post-delivery during the post-epidural round conducted by the resident and pain nurse. Parturients were stratified into one of three categories based on their satisfaction scores. Ordinal logistic regression models were used to identify potential covariates of patient dissatisfaction.Results10,146 parturients were included into the study, of which 3230 (31.8%) were ‘not satisfied’, 3646 (35.9%) were ‘satisfied’, and 3270 (32.2%) were ‘very satisfied’. Multivariable ordinal logistic regression analysis showed that instrument-assisted vaginal delivery (p = 0.0007), higher post-epidural pain score (p = 0.0016), receiving epidural catheter resiting (p < 0.0001), receiving neuraxial analgesia at a more advanced cervical dilation (p = 0.0443), multiparity (p = 0.0039), and post-procedure complications headache (p = 0.0006), backache (p < 0.0001), urinary retention (p = 0.0002) and neural deficit (p = 0.0297) were associated with patient dissatisfaction. Chinese, compared with other ethnicities (p = 0.0104), were more likely to be dissatisfied.ConclusionsOur study has identified several clinical determinants that were independent associated factors for low patient satisfaction. These covariates could be useful in developing a predictive model to detect at-risk parturients and undertake time-sensitive precautionary measures for better patient satisfaction.

Factors predicting patient satisfaction in women with advanced breast cancer: a prospective study

BackgroundThe present study (1) examined patient satisfaction with care over the first year following the diagnosis of advanced breast cancer and (2) tested if unmet health system and information needs, physical symptom distress, and psychological distress predicted patient satisfaction.MethodsProspective study of 213 Chinese women with advanced breast cancer assessed while awaiting or receiving initial chemotherapy (baseline), then again at 1.5-, 3-, 6-, and 12-months post-baseline. Health system and information unmet (HSI) needs, psychological distress, physical symptom distress, and patient satisfaction were assessed at baseline; patient satisfaction was reassessed at each follow-up assessment. Latent growth curve analysis assessed changes in patient satisfaction over the 12 months follow-up; hierarchical multiple regression analysis tested if baseline health system information needs, physical symptom distress, anxiety and depression predicted patient satisfaction at one-year post-baseline.ResultsThe level of patient satisfaction was high and did not change significantly over time. Only HSI needs (β = − 0.27, p < 0.005) significantly associated with baseline patient satisfaction. Patient satisfaction at one-year post-baseline was predicted by HSI needs (β = − 0.26, p < 0.005), Anxiety (β = 0.23, p < 0.05) and Depression (β = − 0.28, p < 0.005), adjusting for the effect of baseline patient satisfaction (β = 0.22, p < 0.005).ConclusionsUnmet health information needs and greater depressive symptoms at initial treatment phased predicted subsequent poorer patient satisfaction. This highlights a need to reinforce the importance of patient-centered care model in managing advanced breast cancer.

Medical treatment or surgery for colorectal endometriosis? Results of a shared decision-making approach.

What is the degree of patient satisfaction in women with symptomatic colorectal endometriosis who choose medical or surgical treatment after a shared decision-making (SDM) process? The degree of satisfaction with treatment was high both in women who chose medical treatment with a low-dose oral contraceptive (OCP) or a progestin, and in those who chose to undergo surgical resection of bowel endometriosis. Hormonal therapies and surgery for colorectal endometriosis have been investigated in non-comparative studies with inconsistent results. Parallel cohort study conducted on 87 women referring to our centre with an indication to surgery for colorectal endometriosis. A standardised SDM process was adopted, allowing women to choose their preferred treatment. Median follow-up was 40 [18-60] months in the medical therapy group and 45 [30-67] in the surgery group. Patients with endometriosis infiltrating the proximal rectum, the rectosigmoid junction, and the sigmoid, not causing severe sub-occlusive symptoms were enroled. A total of 50 patients chose treatment with an OCP (n = 12) or a progestin (n = 38), whereas 37 women confirmed their previous indication to surgery. Patient satisfaction was graded according to a 5-category scale. Variations in bowel and pain symptoms were measured by means of a 0-10 numeric rating scale. Constipation was assessed with the Knowles-Eccersley-Scott Symptom Questionnaire (KESS), health-related quality of life with the Short Form-12 questionnaire (SF-12), psychological status with the Hospital Anxiety and Depression scale (HADS) and sexual functioning with the Female Sexual Function Index (FSFI). Six women in the medical therapy group requested surgery because of drug inefficacy (n = 3) or intolerance (n = 3). Seven major complications were observed in the surgery group (19%). At 12-month follow-up, 39 (78%) women in the medical therapy group were satisfied with their treatment, compared with 28 (76%) in the surgery group (adjusted odds ratio (OR), 1.37; 95% confidence interval (CI), 0.45-4.15; intention-to-treat analysis). Corresponding figures at final follow-up assessment were 72% in the former group and 65% in the latter one (adjusted OR, 1.74; 95% CI, 0.62-4.85). The 60-month cumulative proportion of dissatisfaction-free participants was 71% in the medical therapy group compared with 61% in the surgery group (P = 0.61); the Hazard incidence rate ratio was 1.21 (95% CI, 0.57-2.62). Intestinal complaints were ameliorated by both treatments. Significant between-group differences in favour of medical treatment were observed at 12-month follow-up in diarrhoea, dysmenorrhoea, non-menstrual pelvic pain and SF-12 physical component scores. The total HADS score improved significantly in both groups, whereas the total FSFI score improved only in women who chose medical therapy. As treatments were not randomly assigned, selection bias and confounding are likely. The small sample size exposes to the risk of type II errors. When adequately informed and empowered through a SDM process, most patients with non-occlusive colorectal endometriosis who had already received a surgical indication, preferred medical therapy. The possibility of choosing the preferred treatment may allow maximisation of the potential effect of the interventions. This study was financed by Italian fiscal contribution '5 × 1000'-Ministero dell'Istruzione, dell'Università e della Ricerca-devolved to Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. P.V., M.P.F., R.R., D.D., A.R., P.M., O.D.G. and M.C. declare that they have no conflicts of interest. E.S. received grants from Ferring and Serono.

Comparison of Patient Satisfaction Between General and Spinal Anaesthesia in Emergency Caesarean Deliveries.

Obstetric anaesthesia aims to deliver a healthy baby as well as render a comfortable operation for the mother. This study compared general and spinal anaesthesia in terms of the quality of recovery and patient satisfaction in women undergoing emergency caesarean deliveries. In total, 100 patients were enrolled in this prospective, single-blind, cross-sectional clinical study. Patients were divided into spinal (n=50) and general (n=50) anaesthesia groups. The recovery score, pain and satisfaction were evaluated by Quality of Recovery Score (QoR-40), Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 24 hours postoperatively. The total QoR-40 scores were significantly higher and the total operation time was longer in the spinal anaesthesia group (median score: 194.5 vs. 179.0, p<0.001 and mean±SD: 69.0±13.3 vs. 62.7±13.4 minutes, p=0.02, respectively). There was no significant difference in VAS and NRS scores between the groups. Both spinal anaesthesia and general anaesthesia have advantages and disadvantages in terms of emergency caesarean deliveries. Spinal anaesthesia speeds up the recovery time and enables the mother to return to normal life earlier, while general anaesthesia has a short initiation time and does not affect patient satisfaction.

Abstract 27. The Use of Liposomal Bupivacaine in Patients Undergoing Abdominally-Based Autologous and Implant-Based Breast Reconstruction

Purpose: Federal mandates to reduce opioid use have placed analgesia management in the national conversation. Liposomal bupivacaine (LB) is an effective analgesic in the immediate postoperative period. This study explores the effect of LB on postoperative narcotic use, length of stay (LOS), and patient satisfaction in women undergoing autologous and implant-based breast reconstruction. Methods: In our previous study, patients undergoing autologous (n=37) and implant-based reconstruction (n=20) who were injected with LB demonstrated significantly decreased total and oral narcotic use compared to controls. We subsequently changed our post-operative protocol and examined these changes over a 90-day implementation period. Patients undergoing abdominally-based autologous reconstruction (n=9) were transitioned to oral narcotics on post-operative day (POD) 2 rather than POD 3. Patient controlled analgesia (PCA) was eliminated from post-operative protocol in patients undergoing implant-based reconstruction (n=16). These patients were discharged on POD 1 rather than POD 2. Both patient groups were injected with LB and compared to historic controls. We examined LOS and patient satisfaction as primary outcomes within these populations. Results: Patients undergoing implant-based reconstruction, subjected to the new protocol, demonstrated a decreased length of stay. Utilizing standardized surveys, improvements in pain control were demonstrated with a percentile ranking change from 88th to 99th percentile, pain management summary score improvement from 62nd to 99th percentile, and improvement in pain control ranking from 27th to 99th percentile. Conclusion: This study demonstrates patients undergoing implant and autologous-based breast reconstruction, who receive regional block with LB, use significantly fewer narcotics with decreased LOS and improved satisfaction.

Impact of increasing age on breast reduction surgery: A single centre analysis

Women with hypertrophic breasts suffer for physical and psychological reasons. Breast reduction surgery is a safe procedure that can effectively improve symptoms and quality of life. As most studies have been performed in younger women, little is known about complications and long-term patient satisfaction in elderly women. We analysed complication rates and patient satisfaction in women aged 60 years and older who underwent a bilateral reduction mammaplasty. Patient satisfaction was measured with a validated questionnaire (client satisfaction questionnaire (CSQ)-8). The results obtained were compared to those of a control group including women aged 35 years and younger. Twenty-five women met the inclusion criteria in each group. The mean age in the elderly and young was 65.4 and 23.4 years, respectively. Older women had more comorbidities (35 vs. 9, p < 0.05). The average overall resection weight was 1684.4 g with slightly lower resection weights in younger women (1541 vs. 1828 g; p = 0.34). Eight women in the young group and 11 in the elderly developed minor complications (p = 0.56). Two women in the young group had major complications. Patient satisfaction was significantly higher in older women, with a mean score of 27.3 in the young and 30.3 in the elderly (maximum score of CSQ-8: 32, p < 0.05). Age is not a contraindication for reduction mammaplasty. Breast reduction surgery is a safe procedure in elderly women and leads to even higher patient satisfaction. Level of evidence: IV.

Retrospective Cohort Study to Assess Outcomes, Cost-Effectiveness, and Patient Satisfaction in Primary Vaginal Ovarian Cystectomy versus the Laparoscopic Approach

Study ObjectiveTo compare surgical outcomes, cost-effectiveness, and patient satisfaction in women undergoing primary vaginal or laparoscopic ovarian cystectomy for benign ovarian cysts. DesignRetrospective cohort control study (Canadian Task Force classification II-3). SettingGynecologic unit at a university-affiliated hospital. PatientsFifty patients who underwent primary ovarian cystectomy either through the vaginal route via posterior colpotomy (n = 29) or laparoscopic route (n = 21). InterventionsNonmalignant ovarian cysts were initially determined by transvaginal ultrasonography and serum tumor markers. The index group of women (n = 29) underwent vaginal ovarian cystectomy via a posterior colpotomy incision, whereas the control group (n = 21) comprised women who had laparoscopic ovarian cystectomy using the traditional “grasp and peel” technique. The following outcomes were evaluated: duration of surgery, intraoperative complications, estimated blood loss, length of inpatient stay, and postoperative pain (visual analogue scale). The average cost of both surgical methods was calculated by factoring in theater time, equipment required, and the length of hospital stay. Patients were then surveyed to compare postoperative pain and satisfaction scores as well as the time taken to return to work (in days). Measurements and Main ResultsThe 2 groups had similar mean ages (35.79 vs 36.72 years) and cyst diameter (6.8 vs 6.6 cm) (p > .05 in both cases). Vaginal ovarian cystectomy took a mean of 13.7 minutes longer (91.7 vs 78.0 minutes, p < .001) to perform and resulted in a greater mean estimated blood loss (116.1 vs 95 mL, p < .001). The spillage rate in the index group was 6-fold less compared with control cases (6% ± 2.4% vs 35% ± 4.6, p < .01). Although patients from the index group spent a mean of 2 hours longer as inpatients (10.9 vs 8.9 hours, p < .001), they reported a lower mean visual analogue pain score (2.01/10 vs 3.95/10, p < .05) and higher patient satisfaction scores (8.2/10 vs 6.5/10, p < .001). Mean perioperative cost of women who underwent vaginal ovarian cystectomy was lower (£1690.13 vs 1761.67) and they returned to work quicker compared with the laparoscopic group (13.6 vs 39.2 days, p < .001). ConclusionVaginal ovarian cystectomies took longer to perform and led to longer inpatient stay. However, these women had less postoperative pain and reported higher satisfaction scores compared with laparoscopic ovarian cystectomy, with a quicker return to work. The vaginal approach is a viable and cost-effective alternative to the laparoscopic approach in carefully selected patients.

Effects of Music Therapy on Anesthesia Requirements and Anxiety in Women Undergoing Ambulatory Breast Surgery for Cancer Diagnosis and Treatment: A Randomized Controlled Trial.

To investigate the effect of live and recorded perioperative music therapy on anesthesia requirements, anxiety levels, recovery time, and patient satisfaction in women experiencing surgery for diagnosis or treatment of breast cancer. Between 2012 and 2014, 207 female patients undergoing surgery for potential or known breast cancer were randomly assigned to receive either patient-selected live music (LM) preoperatively with therapist-selected recorded music intraoperatively (n=69), patient-selected recorded music (RM) preoperatively with therapist-selected recorded music intraoperatively (n=70), or usual care (UC) preoperatively with noise-blocking earmuffs intraoperatively (n=68). The LM and the RM groups did not differ significantly from the UC group in the amount of propofol required to reach moderate sedation. Compared with the UC group, both the LM and the RM groups had greater reductions (P<.001) in anxiety scores preoperatively (mean changes [and standard deviation: -30.9 [36.3], -26.8 [29.3], and 0.0 [22.7]), respectively. The LM and RM groups did not differ from the UC group with respect to recovery time; however, the LM group had a shorter recovery time compared with the RM group (a difference of 12.4 minutes; 95% CI, 2.2 to 22.5; P=.018). Satisfaction scores for the LM and RM groups did not differ from those of the UC group. Including music therapy as a complementary modality with cancer surgery may help manage preoperative anxiety in a way that is safe, effective, time-efficient, and enjoyable.