Pelvic organ prolapse surgery and quality of life-a nationwide cohort study : Nationwide cohort study

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Mattsson , N K , Karjalainen , P K , Tolppanen , A-M , Heikkinen , A-M , Sintonen , H , Härkki , P , Nieminen , K & Jalkanen , J 2020 , ' Pelvic organ prolapse surgery and quality of life-a nationwide cohort study : Nationwide cohort study ' , American Journal of Obstetrics and Gynecology , vol. 222 , no. 6 , pp. 588.e1-588.e10 . https://doi.org/10.1016/j.ajog.2019.11.1285

Title: Pelvic organ prolapse surgery and quality of life-a nationwide cohort study : Nationwide cohort study
Author: Mattsson, Nina K.; Karjalainen, Päivi K.; Tolppanen, Anna-Maija; Heikkinen, Anna-Mari; Sintonen, Harri; Härkki, Päivi; Nieminen, Kari; Jalkanen, Jyrki
Contributor: University of Helsinki, Clinicum
University of Helsinki, HUS Gynecology and Obstetrics
Date: 2020-06
Language: eng
Number of pages: 10
Belongs to series: American Journal of Obstetrics and Gynecology
ISSN: 0002-9378
URI: http://hdl.handle.net/10138/330314
Abstract: BACKGROUND: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE: To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN: This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS: In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of ImprovementI. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02-2.81). CONCLUSION: Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.
Subject: 3123 Gynaecology and paediatrics
HRQoL (health-related quality of life)
Patient Global Impression of Improvement
patientreported outcome measure
patient satisfaction
Pelvic Floor Distress Inventory
pelvic organ prolapse
pelvic reconstructive surgery
PFDI-20
PGI-I
POP
quality of life
surgery
urogynecology
15D
OF-LIFE
SYMPTOMS
WOMEN
HRQoL
Patient Global Impression of Improvement
patientreported outcome measure
patient satisfaction
Pelvic Floor Distress Inventory
pelvic organ prolapse
pelvic reconstructive surgery
PFDI-20
PGI-I
POP
quality of life
surgery
urogynecology
15D
OF-LIFE
SYMPTOMS
WOMEN
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