Risk factors predicting the loss of functional independence after obliterative procedures for pelvic organ prolapse

• Published in: International Urogynecology Journal Vol. 32; no. 2; pp. 267 - 272
• Main Authors: Blankenship, Logan, Good, Meadow M., Smotherman, Carmen, Gautam, Shiva, Singh, Ruchira
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2021; Springer Nature B.V
• Subjects: Activities of daily living; Age; Chronic obstructive pulmonary disease; Gynecology; Heart failure; Infections; Medicine; Medicine & Public Health; Obstetrics; Original Article; Patients; Pelvic organ prolapse; Postoperative period; Prostheses; Reconstructive surgery; Regression analysis; Risk factors; Urology; Vagina; Variables; Womens health; Functional status; Colpocleisis; Pelvic organ prolapse; Obliterative vaginal surgery
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-020-04424-z

Introduction and hypothesis
To determine the risk factors associated with loss of functional independence after obliterative procedures for pelvic organ prolapse (POP).
Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was used to collect data on women who underwent obliterative vaginal procedures from 2011 to 2016, using current procedural terminology (CPT) codes for LeFort colpocleisis (57120) and vaginectomy (57110). The criterion for loss of functional independence was a transition from a functionally independent status to a dependent status (discharge to a post-care facility) or death within the 30-day postoperative period. Multivariate regression analysis was utilized to determine factors associated with loss of functional independence.
Results
A total of 1847 women were included in the analysis. A loss of functional independence was noted in 50 of the 1847 women (2.6%). The women who suffered loss of functional independence were older than those who were independent postoperatively (mean age 79.3 years, SD 7.47 vs. 76.7 years, SD 8.1, respectively). On multiple logistic regression analysis, age ≥ 80 years (OR 2.8, 95% CI 1.4–5.5), American Society of Anesthesiologists (ASA) classification ≥ 3 (OR 2.3, CI 1.1–4.7) and length of stay ≥ 5 days (OR 15.2, 95% CI 6.2–37.1) remained significantly associated with an increased risk of loss of functional independence.
Conclusions
Age ≥ 80 years, ASA classification ≥ 3 and longer length of stay are associated with an increased risk of loss of functional independence after an obliterative procedure for pelvic organ prolapse. Consideration of these factors during the preoperative decision-making process may help improve outcomes in this cohort.