Adhesion awareness: a national survey of surgeons.
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.
Schreinemacher
Marc H F
MH
Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
ten Broek
Richard P
RP
Bakkum
Erica A
EA
van Goor
Harry
H
Bouvy
Nicole D
ND
D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D009426:Netherlands; D000267:Tissue Adhesions
Colorectal Dis. 2005 Nov;7(6):551-8
16232234
Colorectal Dis. 2007 Oct;9 Suppl 2:35-8
17824968
Dis Colon Rectum. 2003 Oct;46(10):1310-9
14530667
Fertil Steril. 1998 Oct;70(4):702-11
9797102
Surg Endosc. 2003 Jul;17(7):1017-22
12632122
Colorectal Dis. 2007 Oct;9 Suppl 2:60-5
17824972
Eur J Surg Suppl. 1997;(579):43-5
9195184
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005080
19160246
Colorectal Dis. 2007 Oct;9 Suppl 2:66-72
17824973
JAMA. 1999 Oct 20;282(15):1458-65
10535437
Dis Colon Rectum. 1999 Feb;42(2):241-8
10211502
Ann Surg. 2001 Aug;234(2):256-61
11505072
Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):180-9
20236750
Hum Reprod. 2004 Aug;19(8):1877-85
15178659
Nat Med. 2008 Apr;14(4):437-41
18345012
Cochrane Database Syst Rev. 2009 Jul 08;(3):MR000008
19588449
J Clin Epidemiol. 2007 Dec;60(12):1263-70
17998081
Br J Surg. 2007 Jun;94(6):743-8
17330836
Eur J Surg. 1998 Aug;164(8):587-92
9720935
J Reprod Med. 1999 Apr;44(4):325-31
10319300
Dis Colon Rectum. 2001 Jun;44(6):822-29; discussion 829-30
11391142
Fertil Steril. 2007 Nov;88(5):1413-26
17383643
Lancet. 1999 May 1;353(9163):1476-80
10232313
Ann R Coll Surg Engl. 2006 Jul;88(4):375-82
16834859
Surgery. 1981 Apr;89(4):407-13
7209787
Surgery. 2009 Sep;146(3):462-8
19715802
Int J Surg. 2009 Jun;7(3):187-91
19389492
Am J Surg. 2000 Jul;180(1):33-6
11036136
Br J Surg. 2000 Apr;87(4):467-71
10759744
World J Surg. 2009 Apr;33(4):748-50
19194740
Br J Surg. 2000 Sep;87(9):1240-7
10971435
World J Surg. 2006 Apr;30(4):535-40
16555020
Br J Surg. 2003 Sep;90(9):1147-51
12945085
Br J Surg. 2001 Sep;88(9):1258-63
11531877