title: Functional status and postoperative morbidity in older women with prolapse.
abstract: OBJECTIVE
  We determined the relationship of preoperative functional status to postoperative morbidity after pelvic organ prolapse surgery in women older than 60 years.
  
  
  METHODS
  We performed a retrospective cohort study of 223 women older than 60 years who underwent surgery for stage II or greater pelvic organ prolapse. Our exposure was preoperative functional status, defined as American Society of Anesthesiologists (ASA) physical status class. We compared postoperative outcomes (length of stay in a medical facility, and number and severity of postoperative complications) in women with low functional status (ASA class III) to those in women with high functional status (ASA classes I and II). We determined the association of preoperative functional status with postoperative outcomes on multivariate analysis.
  
  
  RESULTS
  Women in ASA class III were significantly likely to be older (mean ± SD age 72.7 ± 7.3 vs 68.3 ± 6.5 years) and of nonwhite ethnicity (36.1% vs 20.1%), have a higher body mass index (mean 29.5 ± 5.6 vs 26.1 ± 3.8 kg/m(2)) and worse functional comorbidity score (median 3 vs 2), and have undergone obliterative surgery (33.3% vs 9.1%) than women in ASA classes I and II (each p <0.05). Low preoperative functional status was independently associated with increased length of stay in a medical facility (2.13 days, 95% CI 0.57, 3.70, p <0.01) and postoperative complications (OR 2.17, 95% CI 1.03, 4.56), after adjusting for age, body mass index, nonwhite ethnicity, number of comorbidities, surgeon and type of surgery.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA. joy.greer@med.navy.mil
authors.forename: Joy A
authors.initials: JA
authors.lastname: Greer
authors.forename: Gina M
authors.initials: GM
authors.lastname: Northington
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Harvie
authors.forename: Saya
authors.initials: S
authors.lastname: Segal
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Johnson
authors.forename: Lily A
authors.initials: LA
authors.lastname: Arya
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D057234:Preoperative Period; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D053825:Suburethral Slings; D016896:Treatment Outcome
keywords: BMI; FCI; Functional Comorbidity Index; POP; aged; body mass index; complications; pelvic floor disorders; pelvic organ prolapse; prolapse; reconstructive surgical procedures