The Northeastern Society of Plastic Surgeons

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Analysis of factors associated with patient or caretaker regret following surgery for fecal incontinence
Bhalaajee Meenakshi-Sundaram, MD, Caitlin T. Coco, MD, James R. Furr, MD, Byron P. Dubow, MD, Christopher E. Aston, PhD, Jennifer Lewis, ARNP, Gennady Slobodov, MD, Bradley P. Kropp, MD, Dominic C. Frimberger, MD.
University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

BACKGROUND:
The Malone Antegrade Continence Enema (MACE) has been a successful and widely used procedure to achieve fecal continence in children. We present data on the previously uninvestigated issue of patient and caretaker regret following surgery for intractable constipation and fecal incontinence.
METHODS:
We reviewed all patients undergoing antegrade continence enema or cecostomy creation at a single institution between 2006 and 2016. Patients and caretakers were assessed for decisional regret utilizing the Decisional Regret Scale. Results were correlated with demographics, surgical outcomes, and complications.
RESULTS:
81 patients and caretakers provided responses. Decisional regret was noted 43 (53%) including mild regret in 38 (47%) and moderate to severe regret in 5 (6%). No statistically significant difference in regret was noted based on gender, complications, or performance of concomitant procedures. On regression analysis, incontinence was strongly associated (p <0.001) with decisional regret (OR 4.4, 95% CI 1.1-18.1) and regret increased as the age at surgery increased, particularly in patients in whom surgery was performed between 13-15 years of age (13: OR 2.6, 95% CI 1.0-6.4, 14: OR 2.9 95% CI 1.1- 7.8, and 15: OR 3.1 95% CI 1.1-8.8).
CONCLUSIONS:
To our knowledge, this is the first study describing decisional regret after surgery for fecal incontinence. Surgical factors aimed at achieving continence may be effective in reducing postoperative regret. The finding of increased regret in teenage patients compared to younger children should be shared with families as this may impact the age at which surgery for fecal incontinence is pursued.


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