Postoperative caregiver decision regret following velopharyngeal dysfunction surgery

Decision regret (DR) is a powerful factor in medical decision-making, particularly for surgical decisions which carry multiple risks, impact quality of life (QOL), and have uncertain outcomes. While prior studies have investigated caregiver DR after tonsillectomy and otologic surgery, there is a paucity of data assessing DR following pediatric otolaryngology procedures. The aim of this study is to measure DR following velopharyngeal dysfunction (VPD) surgery.

A cross-sectional survey study with chart review was performed of caregivers of children who had VPD surgery performed by a single surgeon at a tertiary children's hospital. Demographic, medical, and surgical history were collected. Surveys assessed postoperative DR (scale 0-100), satisfaction with surgery (0-10), caregiver engagement in decision making, and QOL using the VPI Effects on Life Outcomes (VELO)-parent instrument (0-100).

Of 59 caregivers who received the survey, 27 (45.8 %) completed the surveys. Caregivers felt involved in the decision for surgery (85 %). Postoperative caregiver-reported QOL (mean 81.5) and satisfaction (mean 9.4) were overall high. DR was low (mean 4.4), with 22 caregivers (78.6 %) reporting zero DR. Compared to those with no regret, those with DR > 0 reported lower satisfaction (mean 9.7 vs 8.0, p = 0.002) and worse speech limitations (mean 81.2 vs 67.1, p = 0.015) or situational difficulty (mean 77.7 vs. 51.0, p < 0.001) on VELO subscales.

While DR was overall low following VPD surgery, presence of DR was associated with worse speech-related QOL. Further prospective and multi-institutional study of DR is needed in pediatric otolaryngology to identify predictors of regret and understand treatment outcomes.