The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape
Introduction: Stress urinary incontinence (SUI) has an incidence of 15–80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoper...
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MDPI AG
2020-08-01
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author | Juan Cisneros-Pérez Gemma Yusta-Martín María-Pilar Sánchez-Conde Barbara-Yolanda Padilla-Fernandez Lauro-Sebastian Valverde-Martínez Mario Martin-Hernandez Sara Prieto Nogal Javier Flores-Fraile Manuel Esteban-Fuertes María-Begoña García-Cenador María-Fernanda Lorenzo-Gómez |
author_facet | Juan Cisneros-Pérez Gemma Yusta-Martín María-Pilar Sánchez-Conde Barbara-Yolanda Padilla-Fernandez Lauro-Sebastian Valverde-Martínez Mario Martin-Hernandez Sara Prieto Nogal Javier Flores-Fraile Manuel Esteban-Fuertes María-Begoña García-Cenador María-Fernanda Lorenzo-Gómez |
author_sort | Juan Cisneros-Pérez |
collection | DOAJ |
description | Introduction: Stress urinary incontinence (SUI) has an incidence of 15–80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. Aims: To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. Materials and methods: A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (<i>n</i> = 443): patients with ASA I risk. GB (<i>n</i> = 306): patients with ASA II risk. GC (<i>n</i> = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student’s t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for <i>p</i> < 0.05. Results: Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m<sup>2</sup> (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (<i>p</i> = 0.0221) and GA (10.51%) (<i>p</i> = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. Conclusions: Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery. |
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spelling | doaj.art-83bc638b53e74134830f6381499fc60e2023-11-20T09:49:39ZengMDPI AGJournal of Clinical Medicine2077-03832020-08-0198260710.3390/jcm9082607The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral TapeJuan Cisneros-Pérez0Gemma Yusta-Martín1María-Pilar Sánchez-Conde2Barbara-Yolanda Padilla-Fernandez3Lauro-Sebastian Valverde-Martínez4Mario Martin-Hernandez5Sara Prieto Nogal6Javier Flores-Fraile7Manuel Esteban-Fuertes8María-Begoña García-Cenador9María-Fernanda Lorenzo-Gómez10Department of Surgery, University of Salamanca, 37007 Salamanca, SpainDepartment of Surgery, University of Salamanca, 37007 Salamanca, SpainDepartment of Surgery, University of Salamanca, 37007 Salamanca, SpainSection of Urology, Department of Surgery, University of La Laguna, 38200 San Cristóbal de La Laguna, SpainDepartment of Surgery, University of Salamanca, 37007 Salamanca, SpainRenal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, SpainDepartment of Urology, University Hospital of Ávila, 05071 Ávila, SpainDepartment of Surgery, University of Salamanca, 37007 Salamanca, SpainDepartment of Urology of National University Hospital of Paraplegic, 45004 Toledo, SpainDepartment of Surgery, University of Salamanca, 37007 Salamanca, SpainDepartment of Surgery, University of Salamanca, 37007 Salamanca, SpainIntroduction: Stress urinary incontinence (SUI) has an incidence of 15–80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. Aims: To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. Materials and methods: A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (<i>n</i> = 443): patients with ASA I risk. GB (<i>n</i> = 306): patients with ASA II risk. GC (<i>n</i> = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student’s t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for <i>p</i> < 0.05. Results: Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m<sup>2</sup> (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (<i>p</i> = 0.0221) and GA (10.51%) (<i>p</i> = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. Conclusions: Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.https://www.mdpi.com/2077-0383/9/8/2607postoperative complicationsstress urinary incontinence (SUI)suburethral slingrecovery of function |
spellingShingle | Juan Cisneros-Pérez Gemma Yusta-Martín María-Pilar Sánchez-Conde Barbara-Yolanda Padilla-Fernandez Lauro-Sebastian Valverde-Martínez Mario Martin-Hernandez Sara Prieto Nogal Javier Flores-Fraile Manuel Esteban-Fuertes María-Begoña García-Cenador María-Fernanda Lorenzo-Gómez The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape Journal of Clinical Medicine postoperative complications stress urinary incontinence (SUI) suburethral sling recovery of function |
title | The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape |
title_full | The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape |
title_fullStr | The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape |
title_full_unstemmed | The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape |
title_short | The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape |
title_sort | american society of anesthesiologists physical status asa ps risk group classification can be used to anticipate functional recovery outcomes after the surgical treatment of female urinary incontinence with transobturator suburethral tape |
topic | postoperative complications stress urinary incontinence (SUI) suburethral sling recovery of function |
url | https://www.mdpi.com/2077-0383/9/8/2607 |
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