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

Abstract

To determine the risk factors associated with loss of functional independence after obliterative procedures for pelvic organ prolapse (POP). 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 2011-2016, based on the current procedural terminology (CPT) codes for LeFort Colpocleisis (57120) and vaginectomy (57110). Women who were not functionally independent prior to the procedure and those with unknown discharge destination were excluded from the analysis. Women undergoing a concomitant hysterectomy were identified using CPT codes 59260 to 59294. The criteria for loss of functional independence was a transition of a preoperative functional independent status to a dependent status (discharge to a post-care facility) or death within 30-day postoperative period. Demographic data and peri-operative variables were abstracted and compared between women with postoperative loss of functional independence to the rest of the cohort. Descriptive summaries were frequencies and percentages for categorical variables and mean and standard deviation was for continuous variables. The Pearson’s Chi-square test (or Fisher’s exact test) were utilized to compare the categorical data, and Wilcoxon rank sum test for the continuous variables. Multivariate regression analysis was utilized to determine factors associated with loss of functional independence. P value of <0.05 was considered significant. A total of 1,847 women were included in the analysis. A loss of functional independence was noted in 50 of the 1,847 women (2.6%). Of these, nine (18%) women underwent a concomitant hysterectomy. Majority of the women were whites (84%). The women who suffered loss of functional independence were older than those who were independent postoperatively (mean age 79.3 yrs., SD 7.47 vs 76.7 yrs., SD 8.08 respectively). The factors that were associated with postoperative loss of functional independence were age >80 yrs. (p=0.043), ASA class (p=0.02), duration of procedure (p<0.001), length of stay (p<0.001), and postoperative UTI (p=0.010). On multiple logistic regression analysis, age >80 yrs. (OR 2.774, 95% CI 1.394-5.520), ASA class >3 (OR 2.252, CI 1.071-4.739) and length of stay >5 days (OR 15.188, 95% CI 6.222-37.073) remained significantly associated with an increased risk of loss of functional status. Age >80 years, higher ASA class, and length of stay are associated with an increased risk of loss of functional status after obliterative procedure for pelvic organ prolapse. Consideration of these factors during the operative decision-making process may help improve outcomes in this cohort.