Enhancing Quality of Recovery and Satisfaction in Patients Undergoing Minimally Invasive Gynecologic Surgery: The Utility of Structured Perioperative Education

INTRODUCTION: Minimally invasive gynecologic surgery (MIGS) is now a standard approach for the treatment of a variety of gynecologic conditions. Compared with laparotomy, MIGS is associated with improved perioperative outcomes, fewer complications, less pain and narcotic use, and shorter recovery. The feasibility and safety of same-day discharge (SDD) after MIGS are well established. However, undergoing SDD places the patient in a unique position to self-manage their recovery at home. Perioperative education not only reduces psychological distress but also optimizes the patient experience, leading to an increase in patient satisfaction. Despite clear data endorsing perioperative education and SDD in MIGS, there is a paucity of research evaluating specific methods to enhance perioperative counseling beyond the standard of care provided by each individual surgeon. Thus, it becomes increasingly important to define specific strategies for improving patient retention of perioperative counseling beyond each surgeon’s standard of care. OBJECTIVE: To determine if additional structured perioperative education improves quality of recovery and satisfaction among patients undergoing minimally invasive gynecologic surgery. METHODS: This is a two-phased quality improvement initiative examining Quality of Recovery-15 scores in all patients undergoing MIGS. Secondary outcomes included patient satisfaction and patient ratings regarding their perioperative care and education. Phase 1 examined QoR-15 in patients who received standard counseling from their individual surgeon (SoC). Phase 2 involved the creation and distribution of structured perioperative education in the form of a patient educational video and informative handout. This cohort received both standard of care plus additional education (SoC+E). RESULTS: There were 126 SoC and 96 SoC+E patients. There were no significant differences in age, BMI, and duration of surgery. Approximately 75% of surgeries were performed through multiport laparoscopy. We hypothesized that QoR-15 scores would be higher in the SOC+E cohort. Interestingly, the opposite was true (p=.03). There were no significant differences when patients were asked to rate their recovery and preoperative counseling. Patient satisfaction did not differ between SoC and SoC+E groups with 80% and 74% as “very satisfied” in each cohort, respectively. When patients in the SoC+E group were asked to rate the preoperative video and handout, 45% of patients and 32% of patients “strongly agreed” and “agreed” that the video was helpful. CONCLUSIONS: Our study sought to develop and evaluate specific methods to improve patient recovery and satisfaction in minimally invasive gynecologic surgery. To date, there are no studies evaluating QoR-15 scores in patients undergoing MIGS for benign indications after introduction of additional perioperative education prior to surgery. While our data suggests that quality of recovery scores decrease with the introduction of adjunctive educational resources, it reinforces the significance of individualized surgeon perioperative counseling. Our study also highlights the importance of patient-reported outcome measures, such as the Quality of Recovery-15, in evaluating patient experience in MIGS. More analyses are needed to determine effective tools for patient counseling that will serve as an adjunct to each minimally invasive gynecologic surgeon’s standard of care. Perhaps perioperative educational resources should be tailored to specific procedure type in order to achieve applicability to each patient’s experience.