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Adhesion awareness: a national survey of surgeons.

Schreinemacher MH, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND - World J Surg (2010)

Bottom Line: A majority of surgeons (55.9%) used antiadhesive agents in the past, but only a minority (13.4%) did in the previous year.Of trainees, 82.1% foresaw an increase in the use of antiadhesive agents compared to 64.5% of surgeons (p < 0.001).The magnitude of the problem of postoperative adhesions is underestimated and informed consent is provided inadequately by Dutch surgeons.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.

ABSTRACT

Background: Postoperative adhesions are the most frequent complication of abdominal surgery, leading to high morbidity, mortality, and costs. However, the problem seems to be neglected by surgeons for largely unknown reasons.

Methods: A survey assessing knowledge and personal opinion about the extent and impact of adhesions was sent to all Dutch surgeons and surgical trainees. The informed-consent process and application of antiadhesive agents were questioned in addition.

Results: The response rate was 34.4%. Two thirds of all respondents (67.7%) agreed that adhesions exert a clinically relevant, negative effect. A negative perception of adhesions correlated with a positive attitude regarding adhesion prevention (ρ = 0.182, p < 0.001). However, underestimation of the extent and impact of adhesions resulted in low knowledge scores (mean test score 37.6%). Lower scores correlated with more uncertainty about indications for antiadhesive agents which, in turn, correlated with never having used any of these agents (ρ = 0.140, p = 0.002; ρ = 0.095, p = 0.035; respectively). Four in 10 respondents (40.9%) indicated that they never inform patients on adhesions and only 9.8% informed patients routinely. A majority of surgeons (55.9%) used antiadhesive agents in the past, but only a minority (13.4%) did in the previous year. Of trainees, 82.1% foresaw an increase in the use of antiadhesive agents compared to 64.5% of surgeons (p < 0.001).

Conclusions: The magnitude of the problem of postoperative adhesions is underestimated and informed consent is provided inadequately by Dutch surgeons. Exerting adhesion prevention is related to the perception of and knowledge about adhesions.

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Related in: MedlinePlus

Techniques to minimize adhesions
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Fig2: Techniques to minimize adhesions

Mentions: Four in 10 respondents (39.1%) expressed a positive opinion on adhesion prevention, 22.4% expressed a negative one. In addition, a positive opinion correlated with a negative view of adhesions (ρ = 0.182, p < 0.001). All respondents, except gastrointestinal surgeons, believed more strongly in adhesion prevention for specific indications than for all abdominal surgery (p < 0.001). Significantly more surgeons than trainees believed that a meticulous surgical technique minimizes adhesions (83.5 vs. 65.6%, p < 0.001). Similarly, significantly more gastrointestinal than nongastrointestinal surgeons believed that laparoscopy reduces adhesion formation (90.5 vs. 72.0%, p < 0.001) (Fig. 2).Fig. 2


Adhesion awareness: a national survey of surgeons.

Schreinemacher MH, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND - World J Surg (2010)

Techniques to minimize adhesions
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2982960&req=5

Fig2: Techniques to minimize adhesions
Mentions: Four in 10 respondents (39.1%) expressed a positive opinion on adhesion prevention, 22.4% expressed a negative one. In addition, a positive opinion correlated with a negative view of adhesions (ρ = 0.182, p < 0.001). All respondents, except gastrointestinal surgeons, believed more strongly in adhesion prevention for specific indications than for all abdominal surgery (p < 0.001). Significantly more surgeons than trainees believed that a meticulous surgical technique minimizes adhesions (83.5 vs. 65.6%, p < 0.001). Similarly, significantly more gastrointestinal than nongastrointestinal surgeons believed that laparoscopy reduces adhesion formation (90.5 vs. 72.0%, p < 0.001) (Fig. 2).Fig. 2

Bottom Line: A majority of surgeons (55.9%) used antiadhesive agents in the past, but only a minority (13.4%) did in the previous year.Of trainees, 82.1% foresaw an increase in the use of antiadhesive agents compared to 64.5% of surgeons (p < 0.001).The magnitude of the problem of postoperative adhesions is underestimated and informed consent is provided inadequately by Dutch surgeons.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.

ABSTRACT

Background: Postoperative adhesions are the most frequent complication of abdominal surgery, leading to high morbidity, mortality, and costs. However, the problem seems to be neglected by surgeons for largely unknown reasons.

Methods: A survey assessing knowledge and personal opinion about the extent and impact of adhesions was sent to all Dutch surgeons and surgical trainees. The informed-consent process and application of antiadhesive agents were questioned in addition.

Results: The response rate was 34.4%. Two thirds of all respondents (67.7%) agreed that adhesions exert a clinically relevant, negative effect. A negative perception of adhesions correlated with a positive attitude regarding adhesion prevention (ρ = 0.182, p < 0.001). However, underestimation of the extent and impact of adhesions resulted in low knowledge scores (mean test score 37.6%). Lower scores correlated with more uncertainty about indications for antiadhesive agents which, in turn, correlated with never having used any of these agents (ρ = 0.140, p = 0.002; ρ = 0.095, p = 0.035; respectively). Four in 10 respondents (40.9%) indicated that they never inform patients on adhesions and only 9.8% informed patients routinely. A majority of surgeons (55.9%) used antiadhesive agents in the past, but only a minority (13.4%) did in the previous year. Of trainees, 82.1% foresaw an increase in the use of antiadhesive agents compared to 64.5% of surgeons (p < 0.001).

Conclusions: The magnitude of the problem of postoperative adhesions is underestimated and informed consent is provided inadequately by Dutch surgeons. Exerting adhesion prevention is related to the perception of and knowledge about adhesions.

Show MeSH
Related in: MedlinePlus