title: Adhesion awareness: a nationwide survey of gynaecologists.
abstract: OBJECTIVE
  Adhesions and related complications lead to substantially increased morbidity and mortality which increase medical costs. We investigated the awareness of adhesions among Dutch gynaecologists and gynaecology residents.
  
  
  METHODS
  A survey, assessing knowledge and opinion about adhesions, was sent to a randomly selected group of 381 gynaecologists and 256 residents. In addition, the informed consent process and application of anti-adhesive agents were questioned.
  
  
  RESULTS
  The response rate was 56.9%. Complications due to adhesions were highly underestimated, leading to low knowledge scores (mean score 35.1%). Of all respondents 73.8% agreed that adhesions exert a clinically relevant and negative effect, but only 51.2% expressed a positive opinion on adhesion prevention. This correlated with a stronger belief in the clinically relevant and negative effects of adhesions and the opinion that adhesion prevention belongs to standard care (ρ=0.212, p<0.001; ρ=0.495, p<0.001). Of all respondents 31.4% expressed a positive attitude towards anti-adhesive agents and 19.8% expressed a negative one. A negative attitude correlated with a negative view in terms of cost-benefits (ρ=0.245, p<0.001). Although 43.5% had used anti-adhesive agents in the past year, 20.9% had used them before but stopped using agents in the past year. Only 5.2% routinely included adhesions or related morbidity in the informed consent.
  
  
  CONCLUSIONS
  Awareness of adhesions is limited and informed consent is provided inadequately. Implementing adhesion prevention is related with awareness of adhesions. These findings underline the need to embed adhesions, related morbidity and prevention in educational programmes.
authors.affiliation: Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. t.meuleman@lumc.nl
authors.forename: Tess
authors.initials: T
authors.lastname: Meuleman
authors.forename: Marc H F
authors.initials: MH
authors.lastname: Schreinemacher
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.forename: Erica A
authors.initials: EA
authors.lastname: Bakkum
authors.forename: P Joep
authors.initials: PJ
authors.lastname: Dörr
mesh_terms: D002483:Cellulose, Oxidized / Q000627:therapeutic use; D005260:Female; D005936:Glucans / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000331:legislation & jurisprudence; D006176:Gynecology / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000077607:Icodextrin; D007258:Informed Consent; D008297:Male; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
chemical_list: D002483:Cellulose, Oxidized; D005936:Glucans; C060002:INTERCEED; D000077607:Icodextrin; D005947:Glucose
keywords: Adhesion prevention; Adhesions; Attitude of gynaecologists towards adhesions and adhesion prevention; Postsurgical complication