A Novel Approach To Assessing Patient-Reported Outcomes After Female Cosmetic Genital Surgery
Catherine J. Sinnott, MD, Laurence T. Glickman, MD, Noel B. Natoli, MD, Michael Dobryansky, MD, Haritha B. Veeramachaneni, MD.
Long Island Plastic Surgery Group, Garden City, NY, USA.
PURPOSE: Patient-reported outcomes after female cosmetic genital surgery have been well-documented. Methods for assessing patient-reported outcomes after female cosmetic genital surgery vary widely between studies, and these methods are often very detailed, time-consuming and difficult to reproduce. This paper aimed to assess patient-reported outcomes after female cosmetic genital surgery using a novel and efficient method and survey.
METHODS: A retrospective chart review identified 77 patients who underwent female cosmetic genital surgery performed by one of six plastic surgeons in a large group private plastic surgery practice from 2009 to 2018. Demographic, clinical and operative information were reviewed and recorded. Clinical outcomes were assessed by evaluating postoperative complications. A novel survey was developed and extrapolated from the BREAST-Q, the patient-reported outcome measure after breast surgery, to assess patient-reported outcomes after female cosmetic genital surgery with respect to four domains, including satisfaction with outcome, physical well-being, psychosocial well-being and sexual well-being. The survey included 14 questions with possible responses of "disagree," "somewhat agree" or "strongly agree" and was administered to all patients who underwent female cosmetic genital surgery during the study period by telephone interview. Patient-reported outcomes were assessed by evaluating responses to questions and by comparing preoperative and postoperative responses in individual patients.
RESULTS: 77 women underwent female cosmetic genital surgery during the study period. All patients underwent central wedge excision for labia minora hypertrophy with or without extension for clitoral hood hypertrophy. Over a mean follow-up of 37.4 months, the overall postoperative complication rate was 35.1% (27), which included wound dehiscence, asymmetry or redundancy, hematoma, decreased sensation and dyspareunia, and the revision surgery rate was 27.3% (21 patients). The patient-reported outcomes survey response rate was 50.6% (39 patients), with a mean age of 30.0±11.4 years and a mean body mass index (BMI) of 22.2±3.6 kg/m2, a mean time since surgery of 55.6 months, a revision surgery rate of 25.6% (10 patients) and an overall complication rate of 35.9% (14), which included wound dehiscence, asymmetry or redundancy, decreased sensation and dyspareunia. With regard to satisfaction with outcome, despite the high complication and revision surgery rate, 97.4% (38 patients) felt overall the surgery was a good experience and were satisfied with the results after surgery and only 2.6% (1 patient) did not. When compared to preoperative assessment, patient-reported outcomes after female cosmetic genital surgery showed significant improvement, with regard to physical well-being (97.4% (38) vs. 38.5% (15)), psychosocial well-being (100.0% (39) vs. 5.1% (2)) and sexual well-being (100.0% (39) vs. 12.8% (5)) (p<0.001).
CONCLUSION: This novel and efficient method and survey can be used to assess patient-reported outcomes after female cosmetic genital surgery, with respect to four important domains. Despite a high potential complication and need for revision surgery rate, the vast majority of patients who undergo female cosmetic genital surgery feel it is a good experience, are satisfied with the results after surgery and show significant improvement in patient-reported outcomes after surgery with regard to physical well-being, psychosocial well-being and sexual well-being.
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