Models for Predicting Recurrence, Complications, and Health Status in Women After Pelvic Organ Prolapse Surgery.
Abstract
OBJECTIVE:To develop statistical models predicting recurrent pelvic organ prolapse,
surgical complications, and change in health status 12 months after apical prolapse
surgery. METHODS:Logistic regression models were developed using a combined cohort
from three randomized trials and two prospective cohort studies from 1,301 participants
enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite
recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome
bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery.
Complications were defined as any serious adverse event or Dindo grade III complication
within 12 months of surgery. Significant change in health status was defined as a
minimum important change of SF-6D utility score (±0.035 points) from baseline. Thirty-two
candidate risk factors were considered for each model and model accuracy was measured
using concordance indices. All indices were internally validated using 1,000 bootstrap
resamples to correct for bias. RESULTS:The models accurately predicted composite recurrent
prolapse (concordance index=0.72, 95% CI 0.69-0.76), bothersome vaginal bulge (concordance
index=0.73, 95% CI 0.68-0.77), prolapse beyond the hymen (concordance index=0.74,
95% CI 0.70-0.77), serious adverse event (concordance index=0.60, 95% CI 0.56-0.64),
Dindo grade III or greater complication (concordance index=0.62, 95% CI 0.58-0.66),
and health status improvement (concordance index=0.64, 95% CI 0.62-0.67) or worsening
(concordance index=0.63, 95% CI 0.60-0.67). Calibration curves demonstrated all models
were accurate through clinically useful predicted probabilities. CONCLUSION:These
prediction models are able to provide accurate and discriminating estimates of prolapse
recurrence, complications, and health status 12 months after prolapse surgery.
Type
Journal articleSubject
NICHD Pelvic Floor Disorders NetworkHumans
Urinary Incontinence, Stress
Uterine Prolapse
Recurrence
Postoperative Complications
Reoperation
Gynecologic Surgical Procedures
Models, Statistical
Logistic Models
Risk Assessment
Risk Factors
Cohort Studies
Prospective Studies
Health Status
Female
Suburethral Slings
Randomized Controlled Trials as Topic
Pelvic Organ Prolapse
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https://hdl.handle.net/10161/19758Published Version (Please cite this version)
10.1097/AOG.0000000000002750Publication Info
Jelovsek, J Eric; Chagin, Kevin; Lukacz, Emily S; Nolen, Tracy L; Shepherd, Jonathan
P; Barber, Matthew D; ... NICHD Pelvic Floor Disorders Network (2018). Models for Predicting Recurrence, Complications, and Health Status in Women After
Pelvic Organ Prolapse Surgery. Obstetrics and gynecology, 132(2). pp. 298-309. 10.1097/AOG.0000000000002750. Retrieved from https://hdl.handle.net/10161/19758.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Matthew Don Barber
Edwin Crowell Hamblen Distinguished Professor of Reproductive Biology and Family Planning
John E Jelovsek
Professor of Obstetrics and Gynecology
Dr. Jelovsek is the F. Bayard Carter Distinguished Professor of OBGYN at Duke University
and serves as Director of Data Science for Women’s Health. He is Board Certified in
OBGYN by the American Board of OBGYN and in Female Pelvic Medicine & Reconstructive
Surgery by the American Board of OBGYN and American Board of Urology. He has an active
surgical practice in urogynecology based out of Duke Raleigh. He has expertise as
a clinician-scientist in developing and evaluating clini
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