title: Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study.
abstract: We sought to determine whether frailty affects the type of pelvic organ prolapse surgery performed and the odds of postoperative complications.
  
  
  
  This is a retrospective cohort study of women who underwent obliterative and reconstructive surgery for pelvic organ prolapse in ACS (American College of Surgeons) NSQIP® (National Surgical Quality Improvement Program) from 2005 to 2013. We quantified frailty using NSQIP-FI (Frailty Index) and applied logistic regression models predicting the type of procedure (colpocleisis) and the odds of postoperative complications.
  
  
  
  We identified a total of 12,731 women treated with pelvic organ prolapse repair, of which 5.3% were colpocleisis procedures, from 2005 to 2013. Among women undergoing colpocleisis, the average age was 79.2 years and 28.5% had a NSQIP-FI of 0.18 or higher, indicating frailty. Women undergoing colpocleisis procedures had higher odds of being frail (NSQIP-FI 0.18 vs 0 OR 1.9, 95% CI 1.4-2.6) and were older (age 85+ vs less than 65 years OR 486.4, 95% CI 274.6-861.7). For all types of pelvic organ prolapse procedures, frailty increased the odds of complications (NSQIP-FI 0.18 vs 0 OR 2.8, 95% CI 1.8-3.0), after adjusting for age and type of pelvic organ prolapse procedure.
  
  
  
  For pelvic organ prolapse surgery, age rather than frailty is more strongly associated with the type of procedure performed. However, frailty is more strongly associated with postoperative complications than age. Furthermore, incorporating frailty into preoperative decision making is important to improve expectations and outcomes among older women considering pelvic organ prolapse surgery.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California. Electronic address: Anne.Suskind@ucsf.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.affiliation: Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California.
authors.forename: Chengshi
authors.initials: C
authors.lastname: Jin
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California-San Francisco, San Francisco, California; Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California.
authors.forename: Emily
authors.initials: E
authors.lastname: Finlayson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D000073496:Frailty / Q000150:complications*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: age groups; frail elderly; geriatrics; pelvic organ prolapse; postoperative complications