Table 2.
Risk Factors and their odds ratios (95% confidence intervals) in the Statistical Models to Predict Recurrent Pelvic Organ Prolapse, Complications, and Overall Health Status after Pelvic Organ Prolapse Surgery
| Variables | Models to Predict Recurrent Pelvic Organ Prolapse | Models to Predict Complications | Models to Predict Overall Health Status Using Health Utilities¶¶¶ | ||||
|---|---|---|---|---|---|---|---|
| Composite Definition (n = 1059) | Bothersome Vaginal Bulge (n = 982) | Prolapse Beyond the Vaginal Hymen (n = 1061) | ≥ 1 Serious Adverse Event (n= 1301) | ≥ 1 Dindo Grade 3 or Higher Complication (n = 1301) | Overall Health Status Improves (n = 1118) | Overall Health Status Worsens (n = 1118) | |
| Age | − | 0.98 (0.95,1.01) | − | 1.02 (0.99,1.03) | − | 0.974** (0.96,0.99) | 1.021* (1.00,1.04) |
| Vaginal Parity | 1.117** (1.03,1.21) | 1.11 (0.98,1.25) | − | − | − | − | − |
| Race | − | + | − | + | − | − | + |
| African American | REF | REF | − | REF | − | − | REF |
| Caucasian | 1.68 (0.78,3.66) | 1.07 (0.38,2.98) | − | 0.69 (0.39,1.23) | − | − | 0.527* (0.29,0.95) |
| Other | 2.61 (0.95,7.17) | 2.71 (0.75,9.82) | − | 0.57 (0.22,1.48) | − | − | 0.46 (0.29,0.95) |
| Cardiac Disorder | - | 0.53 (0.25,1.12) | − | − | 1.37 (0.87,2.16) | − | − |
| Upper Gastrointestinal Disorder | 0.594* (0.37,0.95) | 0.55 (0.29,1.04) | 0.66 (0.43,1.02) | − | − | − | − |
| Lower Gastrointestinal Disorder | − | − | − | 0.598* (0.37,0.97) | 0.57 (0.32,1.01) | − | 0.75 (0.46,1.23) |
| Vascular Disorder | − | − | − | 0.78 (0.55,1.12) | − | − | − |
| Connective Tissue Disorder | − | − | − | − | 2.79 (0.83,9.41) | 0.35 (0.11,1.11) | − |
| Current health limits vigorous activities such as running, lifting heavy objects, participating in strenuous sports | − | + | − | − | − | + | + |
| Not Limited at All | − | REF | − | − | − | REF | REF |
| Limited a Little | − | 0.82 (0.41,1.64) | − | − | − | 2.415** (1.68,3.47) | 0.333** (0.22,0.50) |
| Limited a Lot | − | 1.38 (0.72,2.65) | − | − | − | 3.030** (2.11,4.36) | 0.219** (0.14,0.33) |
| Heavy Lifting Frequency | + | + | − | − | + | − | + |
| Never | REF | REF | − | − | REF | − | REF |
| Once a week | 0.91 (0.52,1.59) | 1.17 (0.53,2.62) | 0.96 (0.55, 1.70) | 1.07 (0.65,1.76) | |||
| More than once a week | 1.18 (0.74,1.88) | 1.35 (0.70,2.60) | − | − | 1.07 (0.65, 1.75) | − | 1.10 (0.69,1.73) |
| Less than once a month | 1.49 (0.56,3.98) | 0.64 (0.07,2.60) | − | − | 0.69 (0.29,1.68) | − | 0.82 (0.37,1.84) |
| Once a month | 1.34 (0.79,2.28) | 1.38 (0.65,2.90) | − | − | 0.53 (0.25,1.12) | − | 0.92 (0.52,1.60) |
| Two to three time a month | 1.56 (0.94,2.59) | 1.52 (0.76,3.05) | − | − | 0.91 (0.51,1.61) | − | 1.608* (1.00,2.58) |
| Smoking Status | − | − | − | − | + | + | + |
| Current | − | − | − | − | REF | REF | REF |
| Former | − | − | − | − | 0.68 (0.36,1.30) | 1.68 (0.96,2.92) | 0.57 (0.29,1.12) |
| Never | − | − | − | − | 0.467* (0.25,0.88) | 1.47 (0.86,2.51) | 0.71 (0.37,1.35) |
| Estrogen Therapy | − | − | − | 0.74 (0.53,1.02) | 0.73 (0.50,1.09) | − | − |
| Anticoagulant Use | − | 0.37 (0.05,2.99) | − | − | − | − | − |
| Number of Comorbid Conditions | 1.08 (0.97,1.21) | 1.279** (1.10,1.49) | − | 1.1 (0.99,1.22) | 1.10 (0.98,1.23) | 0.919** (0.85,0.99) | 1.09 (0.99,1.21) |
| Prior Hysterectomy | − | − | − | 0.74 (0.52,1.06) | 0.63 (0.36,1.11) | − | − |
| Body Mass Index ¶¶ | − | − | − | − | − | 0.438* (0.21,0.93) | 0.45 (0.18,1.15) |
| POPQ Stage | − | + | + | + | − | − | − |
| II | − | REF | REF | REF | − | − | − |
| III | − | 0.61 (0.30,1.22) | 2.119* (1.19,3.78) | 1.18 (0.85,1.63) | − | − | − |
| IV | − | 0.5 (0.12,2.14) | 1.8 (0.68,4.73) | 0.88 (0.56,1.40) | − | − | − |
| POPQ C | − | − | − | − | − | 0.97 (0.93,1.01) | 1.03 (0.98,1.08) |
| POPQ Ba | 1.183** (1.09,1.28) | 1.204* (1.02,1.43) | 1.177** (1.05,1.31) | − | − | − | 0.95 (0.87,1.04) |
| POPQ Bp | − | − | − | − | − | 1.058* (1.01,1.11) | − |
| POPQ GH | 1.199** (1.05,1.37) | 1.16 (0.96,1.42) | 1.219** (1.07,1.39) | − | − | 1.09 (0.99,1.19) | − |
| Anesthesia Type | − | 2.18 (0.68,7.03) | − | 1.59 (0.84,2.99) | − | 1.815* (1.03,3.20) | − |
| Concurrent Anterior Repair | 0.648* (0.43,0.94) | 0.563* (0.33,0.98) | 0.575** (0.38,0.86) | − | 1.28 (0.82,2.00) | − | − |
| Concurrent Posterior Repair | 0.618* (0.43,0.90) | 0.523* (0.31,0.89) | 0.622* (0.43,0.91) | − | − | − | − |
| Concurrent Hysterectomy or oophorectomy | − | 0.67 (0.38,1.19) | − | 0.72 (0.52,1.06) | 0.4509** (0.25,0.80) | − | 1.31 (0.90,1.90) |
| Concurrent Continence Procedure | − | − | − | − | + | + | − |
| Burch | − | − | − | − | REF | REF | − |
| Sling/TVT | − | − | − | − | 1.14 (0.52,2.50) | 0.99 (0.56,1.77) | − |
| Other | − | − | − | − | 3.61 (0.77,16.85) | 0.177* (0.03,0.95) | − |
| None | − | − | − | − | 1.40 (0.76,2.58) | 0.81 (0.50,1.31) | − |
| Vault suspension repair type ¶ | + | + | + | + | + | + | + |
| Abdominal sacrocolpopexy | REF | REF | REF | REF | REF | REF | REF |
| Uterosacral Ligament Suspension | 9.443** (5.28,16.90) | 10.283** (4.18,25.28) | 11.111** (6.19,19.94) | 0.428** (0.29,0.62) | 0.378** (0.19,0.74) | 1.684* (1.07,2.65) | 0.94 (0.63,1.41) |
| Sacrospinous Ligament Suspension | 9.443** (5.28,16.90) | 10.283** (4.18,25.28) | 11.111** (6.19,19.94) | 0.473** (0.30,0.74) | 0.443** (0.21,0.95) | 1.805* (1.06,3.09) | 0.83 (0.50,1.38) |
| Other | 9.443** (5.28,16.90) | 10.283** (4.18,25.28) | 11.111** (6.19,19.94) | 0.89 (0.31,2.58) | 0.74 (0.21,2.65) | 1.7 (0.61,4.78) | 0.84 (0.22,3.17) |
| None | 10.160** (3.42,30.17) | 7.027* (1.57,31.53) | 6.893** (1.69,28.05) | 0.212** (0.07,0.63) | 0.147** (0.04,0.59) | 1.97 (0.89,4.37) | 0.81 (0.32,2.04) |
| Colpocleisis | 1.13 (0.51,2.53) | 0.49 (0.09,2.64) | 1.77 (0.88,3.55) | 0.326** (0.18,0.59) | 0.417** (0.19,0.92) | 1.08 (0.61,1.92) | 1.22 (0.66,2.25) |
*
Significant at 0.05
**
Significant at 0.01
REF = Reference category, + = factor present in final model, − = factor not present in final model
Pelvic Organ Prolapse Quantification (POPQ)
¶
One participant received a uterosacral ligament suspension and sacrospinous ligament suspension and was classified as receiving a uterosacral ligament suspension for this analysis
¶¶
Natural log transformation was performed.
¶¶¶
The outcomes were dichotomous. The improving model outcome was the probability of the SF-6D score improving ≥ 0.035 from baseline vs. <0.035 from baseline and the worsening outcome model was the probability of the SF-6D score worsening ≤ −0.035 vs. > −0.035 from baseline.