Functional Status and Postoperative Morbidity in Older Women with Prolapse

Greer, Joy A.; Northington, Gina M.; Harvie, Heidi S.; Segal, Saya; Johnson, Jerry; Arya, Lily A.

doi:10.1016/j.juro.2013.03.004

Cited by 28 publications

(17 citation statements)

References 24 publications

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“…Surgical methods are commonly used to treat urinary incontinence in this age group. Recent studies suggest that the presence of coexisting disabilities is associated with worse functional outcomes following surgery . 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‐existing disabilities are present.…”

Section: Discussionmentioning

confidence: 99%

Urinary incontinence and disability in community-dwelling women: A cross-sectional study

Greer

Propert

et al. 2014

Neurourol. Urodynam.

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Aims Disability, an individual’s reduced capacity to perform physical tasks encountered in daily routine, is associated with urinary incontinence in the elderly. Our objective was to determine if urinary incontinence is associated with disability in community-dwelling women 40 years and older. Methods Cross-sectional study among US women ≥ 40 years (n=4,458) from National Health and Nutrition Examination Surveys 2005–2010. We estimated the age-stratified weighted prevalence and factors independently associated with disability (Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), mobility, and functional limitations) in women with and without urinary incontinence while controlling for confounders of the association between disability and urinary incontinence. Results The weighted prevalence of all disabilities was higher in women with urinary incontinence than women without urinary incontinence across most decades of life with the greatest difference in the prevalence of mobility disabilities: 40–49 years (12.1% versus 7.0%), 50–59 years (17.0% versus 9.2%), 60–69 years (28.3% versus 19.8%), and 70+ years (43.8% versus 33.0%, all P < .05). On multivariable analysis, after controlling for the confounding effect of age, co-morbidities, and income-poverty ratio, urinary incontinence was weakly associated with disabilities. The adjusted odds ratio (95% confidence interval) of disabilities for urinary incontinence was ADL 1.96 (1.07, 3.58), IADL 1.18 (0.78, 1.78), mobility 1.26 (1.01, 1.56) and functional limitations 1.36 (1.07, 1.73). Conclusions Urinary incontinence is weakly associated with disabilities and cannot be implicated as a cause of disability in community dwelling women.

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Section: Discussionmentioning

confidence: 99%

Urinary incontinence and disability in community-dwelling women: A cross-sectional study

Greer

Propert

et al. 2014

Neurourol. Urodynam.

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“…Demographic data, preoperative hematocrit, POP-Quantification Stage (23), and American Society of Anesthesiologist Class (ASA class) were obtained from the patient's chart. ASA class has been previously reported as a useful marker of functional status in orthopedic patients (24) and in women with POP (10). …”

Section: Methodsmentioning

confidence: 99%

“…Objective markers of functional status were useful predictors of worse functional outcomes following cardiac and abdominal surgery in older mostly male patients (3, 8). Data on the postoperative functional status of older women undergoing POP surgery are limited (9, 10). It remains unclear if older women undergoing POP surgery are at increased risk for worse postoperative functional outcomes and whether such outcomes can be predicted by preoperative risk factors.…”

Section: Introductionmentioning

confidence: 99%

Short-Term Postoperative Functional Outcomes in Older Women Undergoing Prolapse Surgery

Greer

Harvie

Andy

et al. 2015

Obstetrics &Amp; Gynecology

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Objective To evaluate if preoperative markers of functional status predict postoperative functional outcomes in older women undergoing surgery for pelvic organ prolapse. Methods Prospective cohort study of women aged 60 years or older who underwent surgery for prolapse. Preoperative functional status was measured using number of functional limitations (such as difficulty walking or climbing), American Society of Anesthesiologist class, anemia, and history of recent weight loss. Our primary outcome was the number of postoperative functional limitations and secondary outcomes were failure to return to baseline functional status and length of stay after surgery. We determined the association of preoperative functional status markers with postoperative outcomes using univariable and multivariable regression. Results In 127 women, presence of a preoperative functional limitation was a significant predictor of a 0.55 (95% CI 0.36, 0.74) increase in the number of postoperative functional limitations after controlling for age, number of preoperative functional limitations, comorbidities, depression, surgeon, type of procedure, and complications (p < .001). History of recent weight loss and anemia increased risk for failure to return to baseline functional status after controlling for surgeon, type of surgery, and complications (RR 2.44 (95% CI 1.26, 4.71) and RR 2.72 (95% CI 1.29, 5.75), respectively). Preoperative markers associated with longer length of stay after surgery were American Society of Anesthesiologist class III (0.83 day (95% CI 0.20, 1.46) and history of weight loss (0.84 day (95% CI 0.13, 1.54). -. Conclusion Preoperative markers of functional status are useful in predicting short-term postoperative functional outcomes in older women undergoing surgery for pelvic organ prolapse.

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“…A study by Greer and colleagues demonstrated that women with impaired preoperative functional status had a 2.13-day longer length of stay (95% CI 0.57—3.70, p<0.01) and higher rates of complications (OR = 2.18; 95% CI = 1.04–4.56) even after controlling for potential confounding factors. 6 The authors used the American Society of Anaesthesiologists physical status classification, which incorporates comorbidities with physical activity measures: climbing stairs and walking city blocks; and thus, implies that impairments in lower body mobility could lead to worse surgical outcomes. Given our results indicating high prevalence (62%) of self-reported limitations in climbing stairs, it may be possible to improve surgical outcomes and shorten inhospital stays in many older women with POP if their lower body mobility is assessed and strategies are taken to improve it prior to surgery.…”

Section: Commentmentioning

confidence: 99%

“…6 The Institute of Medicine has identified the maintenance of functional status as a priority in older women receiving surgical care. 7 In addition, the Centers for Medicare and Medicaid Services are currently working on developing functional status quality measures.…”

Section: Introductionmentioning

confidence: 99%

Functional status in older women diagnosed with pelvic organ prolapse

Sanses

Schiltz

Couri

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there is limited data on the prevalence of functional limitations in older women with pelvic floor disorders. Objective The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse. Study Design This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files between 1992 and 2008. The analysis included 890 women ≥65 years with pelvic organ prolapse. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living, and instrumental activities of daily living domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age. Results The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in activities of daily living and 13.6% in instrumental activities of daily living. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in activities of daily living, and 30.6% vs 6.7% in instrumental activities of daily living, all p<0.01. The odds of all functional limitations also increased significantly with advancing age. Conclusion Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with pelvic organ prolapse, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with pelvic organ prolapse.

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Functional Status and Postoperative Morbidity in Older Women with Prolapse

Abstract: 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.

Cited by 28 publications

References 24 publications

Urinary incontinence and disability in community-dwelling women: A cross-sectional study

Urinary incontinence and disability in community-dwelling women: A cross-sectional study

Short-Term Postoperative Functional Outcomes in Older Women Undergoing Prolapse Surgery

Functional status in older women diagnosed with pelvic organ prolapse

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