Models for Predicting Recurrence, Complications, and Health Status in Women After Pelvic Organ Prolapse Surgery.

Jelovsek, J Eric

Chagin, Kevin

Lukacz, Emily S

Nolen, Tracy L

Shepherd, Jonathan P

Barber, Matthew D

Sung, Vivian

Brubaker, Linda

Norton, Peggy A

Rahn, David D

Smith, Ariana L

Ballard, Alicia

Jeppson, Peter

Meikle, Susan F

Kattan, Michael W

NICHD Pelvic Floor Disorders Network

2020-01-09T19:54:12Z

2020-01-09T19:54:12Z

2018-08

2020-01-09T19:54:11Z

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.

0029-7844

1873-233X

https://hdl.handle.net/10161/19758

eng

Ovid Technologies (Wolters Kluwer Health)

Obstetrics and gynecology

10.1097/AOG.0000000000002750

NICHD Pelvic Floor Disorders Network

Humans

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

Models for Predicting Recurrence, Complications, and Health Status in Women After Pelvic Organ Prolapse Surgery.

Journal article

Jelovsek, J Eric|0000-0002-7196-817X

298

309

2

School of Medicine

Duke

Obstetrics and Gynecology

Clinical Science Departments

Duke Clinical Research Institute

Institutes and Centers

Obstetrics and Gynecology, Urogynecology

Published

132