title: The S.A.C.S. (Satisfaction-Anatomy-Continence-Safety) score for evaluating pelvic organ prolapse surgery: a proposal for an outcome-based scoring system.
abstract: OBJECTIVE
  To date, there is no overall consensus on the definition of cure after surgery for pelvic organ prolapse (POP). The aim of the study was to design and test the scoring system S.A.C.S. (Satisfaction-Anatomy-Continence-Safety) to assess and compare the outcomes of POP repair.
  
  
  METHODS
  A total of 233 women underwent open sacrocolpopexy. The S.A.C.S. outcome scoring system was scheduled at 24 months of follow-up, and each component was detected according to: Satisfaction by mean of Patient Global Improvement Inventory scale, Anatomy by mean of POP Quantification system and bulge symptom, Continence by mean of pad use, and Safety by mean of the Clavien-Dindo classification of surgical complications. Each component produced a binary nominal categorical variable (1 or 0), with a total score of 4 representing cure. As a comparative tool, patients answered a simple yes/no question: "If you had to undergo surgery all over again, would you still do it?". The degree of concordance was estimated using Cohen's Kappa test.
  
  
  RESULTS
  According to the S.A.C.S. scoring system, only 160 patients (68.6 %) reached the maximum score of cure. Sensitivity of the S.A.C.S. score was 74.1 %, specificity was 90 %, total diagnostic capacity was 75.5 %. The S.A.C.S. score internal consistency was good; the k-coefficient was higher for the satisfaction component of the score (k = 0.560).
  
  
  CONCLUSIONS
  This study proposes an original, simple post-operative scoring system integrating satisfaction, anatomy, continence, and safety reports for patients undergoing surgery for POP, providing a complete, although perfectible, method to accurately report outcomes in all clinical scenarios.
authors.affiliation: Department of Urology, Azienda Ospedaliera di Perugia, University of Perugia, Sant'Andrea delle Fratte, Perugia, 06100, Italy, luigi.mearini@tin.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mearini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zucchi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Nunzi
authors.forename: Manuel
authors.initials: M
authors.lastname: Di Biase
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Costantini
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011446:Prospective Studies