Expectations Versus Experience in Urogynecologic Surgery: A Qualitative Study

IMPORTANCE: Studies suggest that patients often do not feel fully prepared for surgery and may experience feelings of apprehension, fear, and distress. More information is needed about exactly how patients' preoperative expectations diverge from surgical experience and postoperative course. OBJECTIVES: The objectives of this study were to explore patient perspectives of the surgical experience, characterize areas of dissonance between expectations and reality, and to identify opportunities to improve perioperative care in urogynecology. STUDY DESIGN: We conducted a qualitative study of patients 6 weeks to 12 months after a hysterectomy with apical suspension. Patients were recruited from a 4-surgeon academic urogynecology practice between December 2022 and May 2024. Participants completed a 1:1 semistructured interview. Thematic analysis was performed using the grounded theory method, and Dedoose Software was used to produce descriptive reports. RESULTS: Twenty-one interviews were completed. Five key themes emerged: (1) preoperative preparations, (2) interpersonal interactions, (3) perioperative stressors, (4) postoperative expectations, and (5) validation of surgical decision. Preoperative concerns included fear of anesthesia, anxiety surrounding voiding trials, and unease about the recovery process. Positive experiences were linked to supportive interactions with surgeons, nursing staff, and loved ones. Unexpected stressors included difficulties with medication access, understaffing, and unanticipated pain (eg, dysuria, shoulder pain, throat pain). Perceptions of recovery varied, but all participants agreed that they would recommend surgery to others, citing improvements in quality of life as a key factor in their satisfaction. CONCLUSIONS: This study identified discrepancies between preoperative expectations and patients' perioperative experiences. Addressing these gaps through enhanced education and communication may reduce preoperative anxiety and improve patient satisfaction.