Functional Status and Postoperative Morbidity in Older Women with Prolapse
Abstract
PURPOSE: We determined the relationship of preoperative functional status to postoperative morbidity after pelvic organ prolapse surgery in women older than 60 years. MATERIALS AND METHODS: We performed a retrospective cohort study of 223 women older than 60 years who underwent surgery for stage II or greater pelvic organ prolapse. Our exposure was preoperative functional status, defined as American Society of Anesthesiologists (ASA) physical status class. We compared postoperative outcomes (length of stay in a medical facility, and number and severity of postoperative complications) in women with low functional status (ASA class III) to those in women with high functional status (ASA classes I and II). We determined the association of preoperative functional status with postoperative outcomes on multivariate analysis. RESULTS: Women in ASA class III were significantly likely to be older (mean ± SD age 72.7 ± 7.3 vs 68.3 ± 6.5 years) and of nonwhite ethnicity (36.1% vs 20.1%), have a higher body mass index (mean 29.5 ± 5.6 vs 26.1 ± 3.8 kg/m(2)) and worse functional comorbidity score (median 3 vs 2), and have undergone obliterative surgery (33.3% vs 9.1%) than women in ASA classes I and II (each p <0.05). Low preoperative functional status was independently associated with increased length of stay in a medical facility (2.13 days, 95% CI 0.57, 3.70, p <0.01) and postoperative complications (OR 2.17, 95% CI 1.03, 4.56), after adjusting for age, body mass index, nonwhite ethnicity, number of comorbidities, surgeon and type of surgery. CONCLUSIONS: As defined by ASA class, preoperative functional status is significantly associated with postoperative length of stay and complications. Preoperative functional status is useful for predicting postoperative outcomes in older women who undergo pelvic organ prolapse surgery.
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Recent studies suggest coexisting disabilities are linked to worse functional outcomes after surgery.
“Recent studies suggest that the presence of coexisting disabilities is associated with worse functional outcomes following surgery.(19, 20)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [20]
Coexisting comorbidities can lead to worse treatment outcomes.
“Coexisting co-morbidities, also common in women with urinary incontinence, can lead to worse treatment outcomes (19–21)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [20]
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“Recent studies suggest that the presence of coexisting disabilities is associated with worse functional outcomes following surgery.(19,20) When planning treatment options for women with urinary incontinence, surgeons need to be cognizant of the possibility of worse outcomes in women with urinary incontinence when co-e…”
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“American Society of Anesthesiologists class has been previously reported as a useful marker of functional status in orthopedic patients24 and in women with POP.10 Surgery for POP was performed by one of three fellowship-trained pelvic reconstructive surgeons in the University of Pennsylvania Health System.”
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“In elderly patients, there has been an association of longer lengths of stay and increased complication risk in women over the age of 60 with an American Society of Anesthesiologists class III [17].”
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BackgroundInfluence of Patientʼs Age on the Outcome of Vaginal and Laparoscopic Procedures in Urogynaecology
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“5,16,17 Although women may experience a short-term worsening of their functional status after surgery, their status can improve in the long term.”
Re: Most Older Women Recover Baseline Functional Status following Pelvic Organ Prolapse Surgery
Griebling, T. L. (2015) · The Journal of Urology · doi:10.1016/j.juro.2015.03.051
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Re: Functional Status in Older Women Diagnosed with Pelvic Organ Prolapse
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“Overall health state (ASA score) has a significant risk on perioperative morbidity (14).”
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“This result is consistent with our clinical experience and can also be compared with the findings of Greer et al., 20 who in 2013 had shown that women with an ASA III score had more perioperative complications after prolapse surgery.”
- Authors
- Greer, J. A., Northington, G. M., Harvie, H. S., Segal, S., Johnson, J. C., & Arya, L. A.
- Affiliations
- Emory University (US)
- Venue
- Journal of Urology
- Published
- 2013-09
- Volume
- 190
- Issue
- 3
- Pages
- 948-952
- ISSN
- 0022-5347 (ISSN-L)
- 1527-3792
- OpenAlex
- W2172076236
- Cited by
- 33
- References
- 26
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 6 · 2014: 7
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic organ prolapse, older women, preoperative functional status, ASA physical status, postoperative morbidity, postoperative complications, length of hospital stay, pelvic floor reconstruction, comorbidities, body mass index
- MeSH terms
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Length of Stay, Middle Aged, Postoperative Complications, Reoperation, Retrospective Studies, Severity of Illness Index, Cohort Studies, Comorbidity, Body Mass Index, Incidence, Multivariate Analysis, Confidence Intervals, Odds Ratio, Treatment Outcome, Age Distribution, Risk Assessment, Plastic Surgery Procedures, Suburethral Slings, Pelvic Organ Prolapse, Preoperative Period
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