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Pelvic Floor Surgery in the Older Woman: Enhanced Compared With Usual Preoperative Assessment

Holly E. Richter, PhD, MD^*, David T. Redden, PhD, Andrew S. Duxbury, MD, Evelyn C. Granieri, MD, MPH^¶, Anne D. Halli and Patricia S. Goode, MD

*Division of Medical Surgical Gynecology, Department of Obstetrics and Gynecology, Department of Biostatistics, and Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham/Atlanta Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Birmingham, Alabama; and ¶Department of Geriatric Medicine, Department of Veterans Affairs Medical Center and Mount Sinai School of Medicine, Bronx, New York.

OBJECTIVE: To examine whether knowledge of deficits obtained in a preoperative geriatric assessment may benefit postoperative health outcomes in older women undergoing pelvic surgery.

METHODS: This study employed a pre–post intervention cohort design. Primary outcome was difference in scores of the Physical Component Summary and Mental Component Summary of the Medical Outcomes Study Short Form 36 Health Survey in 62 older women who had undergone "usual" compared with an "enhanced" preoperative assessment consisting of Activities of Daily Living, Instrumental Activities of Daily Living, Get Up and Go Test, Draw a Clock Test, Mini Nutritional Assessment, Geriatric Depression Scale, and Social Support Scale. The assessment results were placed on the participant's hospital chart. Repeated measures analysis was used.

RESULTS: There were no significant differences in Mental Component Summary scores between the usual and enhanced assessment cohorts preoperatively (mean ± standard deviation; 49.14 ± 10.61 compared with 53.2 ± 9.33), at 6 weeks (53.69 ± 8.61 compared with 55.47 ± 9.46), or at 6 months postoperatively (53.85 ± 10.77 compared with 56.25 ± 7.25); P = .120 for group effect and P = .798 for group by time interaction. Significant time effect was noted (P = .036). There was no significant difference in Physical Component Summary scores between the usual and enhanced assessment cohorts with respect to group effect (P = .986); there was a significant time effect (P = < .001) and a significant group by time interaction (P = .026). Satisfaction with treatment was high in both cohorts at 6 weeks and 6 months.

CONCLUSION: A preoperative geriatric assessment did not seem to have differential benefit in healthy older women undergoing elective pelvic floor surgery.

LEVEL OF EVIDENCE: II-2