Models for Predicting Recurrence, Complications, and Health Status in Women After Pelvic Organ Prolapse Surgery
Open accessAbstract
OBJECTIVE: To develop statistical models predicting recurrent pelvic organ prolapse, surgical complications, and change in health status 12 months after apical prolapse surgery. METHODS: Logistic regression models were developed using a combined cohort from three randomized trials and two prospective cohort studies from 1,301 participants enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery. Complications were defined as any serious adverse event or Dindo grade III complication within 12 months of surgery. Significant change in health status was defined as a minimum important change of SF-6D utility score (±0.035 points) from baseline. Thirty-two candidate risk factors were considered for each model and model accuracy was measured using concordance indices. All indices were internally validated using 1,000 bootstrap resamples to correct for bias. RESULTS: The models accurately predicted composite recurrent prolapse (concordance index=0.72, 95% CI 0.69–0.76), bothersome vaginal bulge (concordance index=0.73, 95% CI 0.68–0.77), prolapse beyond the hymen (concordance index=0.74, 95% CI 0.70–0.77), serious adverse event (concordance index=0.60, 95% CI 0.56–0.64), Dindo grade III or greater complication (concordance index=0.62, 95% CI 0.58–0.66), and health status improvement (concordance index=0.64, 95% CI 0.62–0.67) or worsening (concordance index=0.63, 95% CI 0.60–0.67). Calibration curves demonstrated all models were accurate through clinically useful predicted probabilities. CONCLUSION: These prediction models are able to provide accurate and discriminating estimates of prolapse recurrence, complications, and health status 12 months after prolapse surgery.
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One study reported on the development and internal validation of multivariable prediction models for POP recurrence, but these models have never been externally validated.
“One study reported on the development and internal validation of multivariable prediction models for POP recurrence [18], but these models have never been externally validated.”
From The External Validation of a Multivariable Prediction Model for Recurrent Pelvic Organ Prolapse After Native Tissue Repair: A Prospective Cohort Study (2025) · cites this paper as [18]
The Materials and Methods (page not supplied) describe multivariable recurrence models and internal validation using bootstrap resampling. The Discussion says the models should be externally validated, supporting that they had not been externally validated when the paper was published; the paper cannot establish that they have never been externally validated since then. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA preselection of possible risk factors was made on the basis of current literature, and the number of risk factors for analysis was limited to approximately 10% of the number of failures.
“A preselection of possible risk factors was made on the basis of current literature, 6,12 and the number of risk factors for analysis was limited to approximately 10% of the number of failures.”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [12]
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“One study reported on the development and internal validation of multivariable prediction models for POP recurrence [18], but these models have never been externally validated.”
- Authors
- Jelovsek, J. E., Chagin, K., Lukacz, E. S., Nolen, T. L., Shepherd, J. P., Barber, M. D., Sung, V., Brubaker, L., Norton, P. A., Rahn, D. D., Smith, A. L., Ballard, A., Jeppson, P., Meikle, S. F., Kattan, M. W., & for the NICHD Pelvic Floor Disorders Network
- Affiliations
- Cleveland Clinic (US)
- UC San Diego Health System (US)
- RTI International (US)
- University of Pittsburgh (US)
- Women & Infants Hospital of Rhode Island (US)
- Loyola University Chicago (US)
- University of Utah (US)
- The University of Texas Southwestern Medical Center (US)
- University of Pennsylvania (US)
- University of Alabama at Birmingham (US)
- The University of Texas Health Science Center at Houston (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2018-08
- Volume
- 132
- Issue
- 2
- Pages
- 298-309
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC6060003
- OpenAlex
- W2822216045
- Cited by
- 36
- References
- 18
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 4 · 2023: 8 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 2
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Pfizer
- American Urogynecologic Society
- Boston Scientific Corporation
- National Institutes of Health
- Office of Research on Women's Health
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD069025, U10HD041261, U10HD054136, UG1HD069006, U10HD054214, U01HD041249, U10HD054215, U10HD069010, U10HD069006, U10HD041263, U01HD069031, U10HD069013, U10HD041267, U10HD054241, U10HD041250, UG1HD054214, UG1HD069010, UG1HD054241, U24HD069031)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- pelvic organ prolapse, prolapse recurrence, surgical complications, health status change, prediction model, risk factors, vaginal bulge, women's health
- MeSH terms
- Female, Health Status, Humans, Postoperative Complications, Prospective Studies, Recurrence, Reoperation, Risk Factors, Gynecologic Surgical Procedures, Urinary Incontinence, Stress, Uterine Prolapse, Models, Statistical, Cohort Studies, Logistic Models, Randomized Controlled Trials as Topic, Risk Assessment, Suburethral Slings, Pelvic Organ Prolapse
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