Impact of frailty in benign gynecologic surgery: a systematic review

Abstract

Introduction and hypothesis

Frailty has been associated with increased risks of perioperative complications. This systematic review explores the associations between preoperative frailty and perioperative complications in benign gynecologic surgery.

Methods

A comprehensive, systematic literature search was conducted using the PubMed interface for Medline, Embase, and Scopus databases through August 12, 2020. Articles were included if they described the utilization of frailty assessment tools in benign gynecologic patients in the pre- or perioperative setting. Study quality and evidence were evaluated by the Cochrane Risk of Bias Tool in Non-Randomized Studies and Grading of Recommendations, Assessments, Development, and Evaluations criteria.

Results

One thousand one hundred twenty unique citations were identified, and five studies assessing frailty and perioperative outcomes were included. Three retrospective cohort studies utilized the American College of Surgeons National Surgical Quality Improvement Program database to assess the impact of frailty on perioperative outcomes in hysterectomies and pelvic organ prolapse repair procedures. One retrospective cohort study utilized a California database to assess frailty in prolapse repair surgeries. One cross-sectional study assessed frailty in new urogynecology patient visits. Four of these studies found that preoperative frailty is associated with an increased risk of perioperative complications. Overall, the evidence from the included studies is of low quality and at moderate to critical risk of bias.

Conclusions

There are few studies assessing the impact of frailty on perioperative complications in benign gynecologic surgery. This review demonstrates that preoperative frailty is significantly associated with adverse perioperative outcomes, but additional studies are needed to further explore this association.

Appendix 1: Search terms for systematic review

PubMed

(“Menopause”[Mesh] OR “Genital Diseases, Female”[Mesh] OR “Genitalia, Female”[Mesh] OR “gynecology”[tiab] OR “gynecologic”[tiab] OR “vagina”[tw] OR “vaginal”[tw] OR “uterus”[tw] OR “uterine”[tw] OR “cervix”[tw] OR “cervical”[tw] OR “ovary”[tw] OR “ovarian”[tw] OR “ovaries”[tw] OR “vulva”[tw] OR “pelvic floor disorder”[tiab] OR “pelvic floor disorders”[tiab] OR “pelvic floor dysfunction”[tiab] OR “endometriosis”[tiab] OR urogynecolog*[tiab] OR “Pelvic Organ Prolapse”[Mesh] OR “pelvic organ prolapse”[tiab] OR “cystocele”[tiab] OR “rectocele”[tiab] OR “enterocele”[tiab] OR “apical prolapse”[tiab] OR “urogenital prolapse”[tiab] OR “urinary bladder prolapse”[tiab] OR “menopause”[tiab] OR “menopausal”[tiab] OR “Post menopause”[tiab] OR “Post menopausal”[tiab] OR “Postmenopause”[tiab] OR “Postmenopausal”[tiab] OR “Perimenopause”[tiab] OR “Perimenopausal”[tiab] OR “Premenopause”[tiab] OR “premenopausal”[tiab] OR “Adenomyosis”[tiab] OR “Adnexal Diseases”[tiab] OR “Anovulation”[tiab] OR “Dyspareunia”[tiab] OR “Endometrial”[tiab] OR “Endometritis”[tiab] OR “endometrium”[tiab] OR “Fallopian Tube”[tiab] OR “Fallopian tubes”[tiab] OR “Gynatresia”[tiab] OR “Hematocolpos”[tiab] OR “Hematometra”[tiab] OR “Hydrocolpos”[tiab] OR “Menorrhagia”[tiab] OR “Oophoritis”[tiab] OR “Parametritis”[tiab] OR “Pyometra”[tiab] OR “Rectovaginal”[tiab] OR “Salpingitis”[tiab] OR “Vaginismus”[tiab] OR “Vaginitis”[tiab] OR “Vaginosis”[tiab] OR “Vesicovaginal”[tiab] OR “Vulvitis”[tiab] OR “Vulvodynia”[tiab] OR “Vulvovaginal”[tiab] OR “Vulvovaginitis”[tiab] OR ((“Herpes”[tw] OR “Infertility”[tiab] OR “Sexual Dysfunction”[tw] OR “Genital”[tiab] OR “genitals”[tiab] OR “Reproductive Tract Infections”[tiab] OR “Reproductive Tract Infection”[tiab] OR “Sexually Transmitted Diseases”[tiab] OR “Sexually Transmitted Diseases”[tiab] OR “STD”[tiab] OR “STDs”[tiab]) AND (“female”[tw] OR “females”[tw] OR “women”[tiab] OR “woman”[tiab])) OR “Genital Neoplasms, Female”[Mesh] OR “Luteoma”[Mesh] OR “Granulosa Cell Tumor”[Mesh] OR “Meigs Syndrome”[Mesh] OR “Thecoma”[Mesh] OR “Urinary Incontinence”[Mesh] OR “urinary incontinence”[tiab] OR “stress urinary incontinence”[tiab] OR “mixed urinary incontinence”[tiab] OR “urgency incontinence”[tiab] OR “overactive bladder”[tiab] OR “nocturia”[tiab] OR “urinary urgency”[tiab] OR “urinary frequency”[tiab] OR “Brenner Tumor”[tiab] OR “Cancer of Endometrium”[tiab] OR “Cancer of the Uterus”[tiab] OR “Cancer of Uterus”[tiab] OR “Cervical Cancer”[tiab] OR “Cervical Cancers”[tiab] OR “Cervical Neoplasm”[tiab] OR “Cervical Neoplasms”[tiab] OR “Cervix Cancer”[tiab] OR “Cervix Neoplasm”[tiab] OR “Cervix Neoplasms”[tiab] OR “Endometrial Cancer”[tiab] OR “Endometrial Cancers”[tiab] OR “Endometrial Carcinoma”[tiab] OR “Endometrial Carcinomas”[tiab] OR “Endometrial Neoplasm”[tiab] OR “Endometrial Neoplasms”[tiab] OR “Endometrium Cancer”[tiab] OR “Endometrium Cancers”[tiab] OR “Endometrium Carcinoma”[tiab] OR “Endometrium Carcinomas”[tiab] OR “Female Genital Neoplasm”[tiab] OR “Female Genital Neoplasms”[tiab] OR “Granulosa Cell Tumor”[tiab] OR “Gynecologic Neoplasm”[tiab] OR “Gynecologic Neoplasms”[tiab] OR “Luteoma”[tiab] OR “Meigs Syndrome”[tiab] OR “Ovarian Cancer “[tiab] OR “Ovarian carcinoma”[tiab] OR “Ovarian Neoplasms”[tiab] OR “Thecoma”[tiab] OR “Uterine Cancer”[tiab] OR “Uterine Cancers”[tiab] OR “Uterine Cervical Neoplasms”[tiab] OR “Uterine Neoplasm”[tiab] OR “Uterine Neoplasms”[tiab] OR “Uterus Cancer”[tiab] OR “Uterus Cancers”[tiab] OR “Uterus Neoplasm”[tiab] OR “Uterus Neoplasms”[tiab] OR “Vaginal Neoplasms”[tiab] OR “Vulvar Neoplasms”[tiab] OR “Cervix cancers”[tiab] OR “Gynecologic Surgical Procedures”[Mesh] OR “Endometrial Ablation Techniques”[Mesh] OR “Endometrial Ablation”[tiab] OR “Endometrial Ablations”[tiab] OR “Endometrium ablations”[tiab] OR “Endometrium ablation”[tiab] OR “Endometrial resection”[tiab] OR “Endometrium resection”[tiab] OR “Endometrial resections”[tiab] OR “Endometrium resections”[tiab] OR “Hysterectomy”[Mesh] OR “Hysterectomy”[tiab] OR “hysterectomies”[tiab] OR “colpohysterectomy”[tiab] OR “hysterocolpectomy”[tiab] OR “panhysterectomy”[tiab] OR “colpectomy”[tiab] OR “Colpocleisis”[tiab] OR “Sacrocolpopexy”[tiab] OR “Colpopexy”[tiab] OR “Anterior repair”[tiab] OR “anterior colporrhaphy”[tiab] OR “posterior repair”[tiab] OR “posterior colporrhaphy”[tiab] OR “perineoplasty”[tiab] OR “perineorrhaphy”[tiab] OR “mid-urethral sling”[tiab] OR “transobturator tape”[tiab] OR “incontinence sling”[tiab] OR “supervaginal amputation”[tiab] OR “total hysterectomy”[tiab] OR “uterus amputation”[tiab] OR “uterus extirpation” OR “Hysterectomy, Vaginal”[Mesh] OR “Colpohysterectomy”[tiab] OR “Colpohysterectomies”[tiab] OR “Trachelectomy”[Mesh] OR “Trachelectomies”[tiab] OR “Cervicectomy”[tiab] OR “Cervicectomies”[tiab] OR “Trachelectomy”[tiab] OR “Hysteroscopy”[Mesh] OR “Hysteroscopic “[tiab] OR “Hysteroscopies”[tiab] OR “Hysteroscopy”[tiab] OR “Uterine Endoscopies”[tiab] OR “Uterine Endoscopy”[tiab] OR “Uteroscopies”[tiab] OR “Uteroscopy”[tiab] OR “Ovariectomy”[Mesh] OR “Oophorectomies”[tiab] OR “Oophorectomy”[tiab] OR “oophorotomy”[tiab] OR “ovarectomy”[tiab] OR “Ovariectomies”[tiab] OR “Ovariectomy “[tiab] OR “ovariotomy”[tiab] OR “ovarotomy”[tiab] OR “ovary resection”[tiab] OR “Salpingo-oophorectomy”[Mesh] OR “Salpingo oophorectomy”[tiab] OR “Salpingo oophorectomies”[tiab] OR “salpingooophorectomy”[tiab] OR “salpingooophorectomies”[tiab] OR “uterine adnexectomy”[tiab] OR “salpingo ophorectomies”[tiab] OR “salpingo ophorectomy” OR “Salpingectomy”[Mesh] OR “salpingectomia”[tiab] OR “Salpingectomy”[tiab] OR “Salpingectomies”[tiab] OR “Tubectomy”[tiab] OR “Tubectomies”[tiab] OR “Tubal Excision”[tiab] OR “Tubal Excisions” OR “Salpingostomy”[Mesh] OR “Salpingostomy”[tiab] OR “Salpingostomies”[tiab] OR “Sterilization, Tubal”[Mesh] OR “Aldridge Procedure”[tiab] OR “Cooke Method”[tiab] OR “Cornual Coagulation”[tiab] OR “Cornual Coagulations”[tiab] OR “Fimbriectomies”[tiab] OR “Fimbriectomy”[tiab] OR “Irving Method”[tiab] OR “Kroener Fimbriectomy”[tiab] OR “Kroener Method”[tiab] OR “Madlener Method”[tiab] OR “Pomeroy Method”[tiab] OR “Pomeroy Sterilization”[tiab] OR “Tubal Ligation”[tiab] OR “Tubal Ligations”[tiab] OR “Tubal Occlusion”[tiab] OR “Tubal Occlusions”[tiab] OR “Tubal Ring”[tiab] OR “Tubal Rings”[tiab] OR “Tubal Sterilization”[tiab] OR “Tubal Sterilizations”[tiab] OR “Tube Sterilization”[tiab] OR “Tube Sterilizations”[tiab] OR “tubal sterilization”[tiab] OR “tubal sterilizations”[tiab] OR “tube sterilization”[tiab] OR “tube sterilizations”[tiab] OR “Uchida Method”[tiab] OR “Uterine Myomectomy”[Mesh] OR “Myomectomy”[tiab] OR “Myomectomies”[tiab] OR “Fibroidectomy”[tiab] OR “Fibroidectomies”[tiab] OR “Myomatectomy”[tiab] OR “myomotomy”[tiab] OR “Myomatectomies”[tiab] OR “myomotomies”[tiab])

AND

(((“Frailty”[Mesh] OR “frail elderly”[mh] OR “frail”[tiab] OR “frailty”[tiab] OR “prefrail”[tiab] OR “pre frail”[tiab] OR “prefrailty”[tiab] OR “pre frailty”[tiab] OR “frailities”[tiab]) AND (“Surveys and Questionnaires”[Mesh] OR “Geriatric Assessment”[Mesh] OR “risk assessment”[mh] OR Assess*[tiab] OR Checklist*[tiab] OR Instrument*[tiab] OR Interview*[tiab] OR Inventory[tiab] OR Measure*[tiab] OR Questionnaire*[tiab] OR “Recall”[tiab] OR Record*[tiab] OR Screen*[tiab] OR Self-report*[tiab] OR Survey*[tiab] OR Tool*[tiab])) OR “Physical Frailty Phenotype”[tw] OR “Deficit Accumulation Index”[tw] OR “Gill Frailty Measure”[tw] OR “Clinical Frailty Scale”[tw] OR “Winograd Screening Instrument”[tw] OR “Brief Frailty Instrument”[tw] OR “FRAIL Scale”[tw] OR “Vulnerable Elders Survey”[tw] OR “NSQIP-FI”[tiab] OR “Edmonton Frail Scale”[tw] OR (NSQIP[tiab] AND (“frail”[tiab] OR “fraility”[tiab])))

Embase

(‘menopause’/exp. OR ‘menopause and climacterium’/exp. OR ‘gynecologic disease’/exp. OR ‘female genital system’/exp. OR ‘pelvic floor prolapse’/exp. OR ‘pelvic floor disorder’/exp. OR ‘gynecology’:ti,ab OR ‘gynecologic’:ti,ab OR ‘vagina’:ti,ab,kw OR ‘vaginal’:ti,ab,kw OR ‘uterus’:ti,ab,kw OR ‘uterine’:ti,ab,kw OR ‘cervix’:ti,ab,kw OR ‘cervical’:ti,ab,kw OR ‘ovary’:ti,ab,kw OR ‘ovarian’:ti,ab,kw OR ‘ovaries’:ti,ab,kw OR ‘vulva’:ti,ab,kw OR ‘pelvic floor disorder’:ti,ab OR ‘pelvic floor disorders’:ti,ab OR ‘pelvic floor dysfunction’:ti,ab OR ‘endometriosis’:ti,ab OR urogynecolog*:ti,ab OR ‘pelvic organ prolapse’/exp. OR ‘pelvic organ prolapse’:ti,ab OR ‘cystocele’:ti,ab OR ‘rectocele’:ti,ab OR ‘enterocele’:ti,ab OR ‘apical prolapse’:ti,ab OR ‘urogenital prolapse’:ti,ab OR ‘urinary bladder prolapse’:ti,ab OR ‘menopause’:ti,ab OR ‘menopausal’:ti,ab OR ‘Post menopause’:ti,ab OR ‘Post menopausal’:ti,ab OR ‘Postmenopause’:ti,ab OR ‘Postmenopausal’:ti,ab OR ‘Perimenopause’:ti,ab OR ‘Perimenopausal’:ti,ab OR ‘Premenopause’:ti,ab OR ‘premenopausal’:ti,ab OR ‘Adenomyosis’:ti,ab OR ‘Adnexal Diseases’:ti,ab OR ‘Anovulation’:ti,ab OR ‘Dyspareunia’:ti,ab OR ‘Endometrial’:ti,ab OR ‘Endometritis’:ti,ab OR ‘endometrium’:ti,ab OR ‘Fallopian Tube’:ti,ab OR ‘Fallopian tubes’:ti,ab OR ‘Gynatresia’:ti,ab OR ‘Hematocolpos’:ti,ab OR ‘Hematometra’:ti,ab OR ‘Hydrocolpos’:ti,ab OR ‘Menorrhagia’:ti,ab OR ‘Oophoritis’:ti,ab OR ‘Parametritis’:ti,ab OR ‘Pyometra’:ti,ab OR ‘Rectovaginal’:ti,ab OR ‘Salpingitis’:ti,ab OR ‘Vaginismus’:ti,ab OR ‘Vaginitis’:ti,ab OR ‘Vaginosis’:ti,ab OR ‘Vesicovaginal’:ti,ab OR ‘Vulvitis’:ti,ab OR ‘Vulvodynia’:ti,ab OR ‘Vulvovaginal’:ti,ab OR ‘Vulvovaginitis’:ti,ab OR ((‘Herpes’:ti,ab,kw OR ‘Infertility’:ti,ab OR ‘Sexual Dysfunction’:ti,ab,kw OR ‘Genital’:ti,ab OR ‘genitals’:ti,ab OR ‘Reproductive Tract Infections’:ti,ab OR ‘Reproductive Tract Infection’:ti,ab OR ‘Sexually Transmitted Diseases’:ti,ab OR ‘Sexually Transmitted Diseases’:ti,ab OR ‘STD’:ti,ab OR ‘STDs’:ti,ab) AND (‘female’:ti,ab,kw OR ‘females’:ti,ab,kw OR ‘women’:ti,ab OR ‘woman’:ti,ab)) OR ‘female genital tract tumor’/exp. OR ‘luteoma’/exp. OR ‘granulosa cell tumor’/exp. OR ‘Meigs syndrome’/exp. OR ‘thecoma’/exp. OR ‘urine incontinence’/de OR ‘mixed incontinence’/exp. OR ‘stress incontinence’/exp. OR ‘urge incontinence’/exp. OR ‘urinary incontinence’:ti,ab OR ‘stress urinary incontinence’:ti,ab OR ‘mixed urinary incontinence’:ti,ab OR ‘urgency incontinence’:ti,ab OR ‘overactive bladder’:ti,ab OR ‘nocturia’:ti,ab OR ‘urinary urgency’:ti,ab OR ‘urinary frequency’:ti,ab OR ‘Brenner Tumor’:ti,ab OR ‘Cancer of Endometrium’:ti,ab OR ‘Cancer of the Uterus’:ti,ab OR ‘Cancer of Uterus’:ti,ab OR ‘Cervical Cancer’:ti,ab OR ‘Cervical Cancers’:ti,ab OR ‘Cervical Neoplasm’:ti,ab OR ‘Cervical Neoplasms’:ti,ab OR ‘Cervix Cancer’:ti,ab OR ‘Cervix Neoplasm’:ti,ab OR ‘Cervix Neoplasms’:ti,ab OR ‘Endometrial Cancer’:ti,ab OR ‘Endometrial Cancers’:ti,ab OR ‘Endometrial Carcinoma’:ti,ab OR ‘Endometrial Carcinomas’:ti,ab OR ‘Endometrial Neoplasm’:ti,ab OR ‘Endometrial Neoplasms’:ti,ab OR ‘Endometrium Cancer’:ti,ab OR ‘Endometrium Cancers’:ti,ab OR ‘Endometrium Carcinoma’:ti,ab OR ‘Endometrium Carcinomas’:ti,ab OR ‘Female Genital Neoplasm’:ti,ab OR ‘Female Genital Neoplasms’:ti,ab OR ‘Granulosa Cell Tumor’:ti,ab OR ‘Gynecologic Neoplasm’:ti,ab OR ‘Gynecologic Neoplasms’:ti,ab OR ‘Luteoma’:ti,ab OR ‘Meigs Syndrome’:ti,ab OR ‘Ovarian Cancer’:ti,ab OR ‘Ovarian carcinoma’:ti,ab OR ‘Ovarian Neoplasms’:ti,ab OR ‘Thecoma’:ti,ab OR ‘Uterine Cancer’:ti,ab OR ‘Uterine Cancers’:ti,ab OR ‘Uterine Cervical Neoplasms’:ti,ab OR ‘Uterine Neoplasm’:ti,ab OR ‘Uterine Neoplasms’:ti,ab OR ‘Uterus Cancer’:ti,ab OR ‘Uterus Cancers’:ti,ab OR ‘Uterus Neoplasm’:ti,ab OR ‘Uterus Neoplasms’:ti,ab OR ‘Vaginal Neoplasms’:ti,ab OR ‘Vulvar Neoplasms’:ti,ab OR ‘Cervix cancers’:ti,ab OR ‘gynecologic surgery’/exp. OR ‘endometrium ablation’/exp. OR ‘Endometrial Ablation’:ti,ab OR ‘Endometrial Ablations’:ti,ab OR ‘Endometrium ablations’:ti,ab OR ‘Endometrium ablation’:ti,ab OR ‘Endometrial resection’:ti,ab OR ‘Endometrium resection’:ti,ab OR ‘Endometrial resections’:ti,ab OR ‘Endometrium resections’:ti,ab OR ‘hysterectomy’/exp. OR ‘Hysterectomy’:ti,ab OR ‘hysterectomies’:ti,ab OR ‘colpohysterectomy’:ti,ab OR ‘hysterocolpectomy’:ti,ab OR ‘panhysterectomy’:ti,ab OR ‘colpectomy’:ti,ab OR ‘Colpocleisis’:ti,ab OR ‘Sacrocolpopexy’:ti,ab OR ‘Colpopexy’:ti,ab OR ‘Anterior repair’:ti,ab OR ‘anterior colporrhaphy’:ti,ab OR ‘posterior repair’:ti,ab OR ‘posterior colporrhaphy’:ti,ab OR ‘perineoplasty’:ti,ab OR ‘perineorrhaphy’:ti,ab OR ‘mid-urethral sling’:ti,ab OR ‘transobturator tape’:ti,ab OR ‘incontinence sling’:ti,ab OR ‘supervaginal amputation’:ti,ab OR ‘total hysterectomy’:ti,ab OR ‘uterus amputation’:ti,ab OR ‘uterus extirpation’ OR ‘vaginal hysterectomy’/exp. OR ‘Colpohysterectomy’:ti,ab OR ‘Colpohysterectomies’:ti,ab OR ‘cervicectomy’/exp. OR ‘Trachelectomies’:ti,ab OR ‘Cervicectomy’:ti,ab OR ‘Cervicectomies’:ti,ab OR ‘Trachelectomy’:ti,ab OR ‘hysteroscopy’/exp. OR ‘Hysteroscopic‘:ti,ab OR ‘Hysteroscopies’:ti,ab OR ‘Hysteroscopy’:ti,ab OR ‘Uterine Endoscopies’:ti,ab OR ‘Uterine Endoscopy’:ti,ab OR ‘Uteroscopies’:ti,ab OR ‘Uteroscopy’:ti,ab OR ‘ovariectomy’/exp. OR ‘Oophorectomies’:ti,ab OR ‘Oophorectomy’:ti,ab OR ‘oophorotomy’:ti,ab OR ‘ovarectomy’:ti,ab OR ‘Ovariectomies’:ti,ab OR ‘Ovariectomy‘:ti,ab OR ‘ovariotomy’:ti,ab OR ‘ovarotomy’:ti,ab OR ‘ovary resection’:ti,ab OR ‘salpingooophorectomy’/exp. OR ‘Salpingo oophorectomy’:ti,ab OR ‘Salpingo oophorectomies’:ti,ab OR ‘salpingooophorectomy’:ti,ab OR ‘salpingooophorectomies’:ti,ab OR ‘uterine adnexectomy’:ti,ab OR ‘salpingo ophorectomies’:ti,ab OR ‘salpingo ophorectomy’ OR ‘salpingectomy’/exp. OR ‘salpingectomia’:ti,ab OR ‘Salpingectomy’:ti,ab OR ‘Salpingectomies’:ti,ab OR ‘Tubectomy’:ti,ab OR ‘Tubectomies’:ti,ab OR ‘Tubal Excision’:ti,ab OR ‘Tubal Excisions’ OR ‘salpingostomy’/exp. OR ‘Salpingostomy’:ti,ab OR ‘Salpingostomies’:ti,ab OR ‘uterine tube sterilization’/exp. OR ‘Aldridge Procedure’:ti,ab OR ‘Cooke Method’:ti,ab OR ‘Cornual Coagulation’:ti,ab OR ‘Cornual Coagulations’:ti,ab OR ‘Fimbriectomies’:ti,ab OR ‘Fimbriectomy’:ti,ab OR ‘Irving Method’:ti,ab OR ‘Kroener Fimbriectomy’:ti,ab OR ‘Kroener Method’:ti,ab OR ‘Madlener Method’:ti,ab OR ‘Pomeroy Method’:ti,ab OR ‘Pomeroy Sterilization’:ti,ab OR ‘Tubal Ligation’:ti,ab OR ‘Tubal Ligations’:ti,ab OR ‘Tubal Occlusion’:ti,ab OR ‘Tubal Occlusions’:ti,ab OR ‘Tubal Ring’:ti,ab OR ‘Tubal Rings’:ti,ab OR ‘Tubal Sterilization’:ti,ab OR ‘Tubal Sterilizations’:ti,ab OR ‘Tube Sterilization’:ti,ab OR ‘Tube Sterilizations’:ti,ab OR ‘tubal sterilization’:ti,ab OR ‘tubal sterilizations’:ti,ab OR ‘tube sterilization’:ti,ab OR ‘tube sterilizations’:ti,ab OR ‘Uchida Method’:ti,ab OR ‘myomectomy’/exp. OR ‘Myomectomy’:ti,ab OR ‘Myomectomies’:ti,ab OR ‘Fibroidectomy’:ti,ab OR ‘Fibroidectomies’:ti,ab OR ‘Myomatectomy’:ti,ab OR ‘myomotomy’:ti,ab OR ‘Myomatectomies’:ti,ab OR ‘myomotomies’:ti,ab)

AND

(((‘frailty’/exp. OR ‘frail elderly’/exp. OR ‘frail’:ti,ab OR ‘frailty’:ti,ab OR ‘prefrail’:ti,ab OR ‘pre frail’:ti,ab OR ‘prefrailty’:ti,ab OR ‘pre frailty’:ti,ab OR ‘frailities’:ti,ab) AND (‘questionnaire’/exp. OR ‘survey’/exp. OR ‘health survey’/exp. OR ‘geriatric assessment’/exp. OR ‘risk assessment’/exp. OR Assess*:ti,ab OR Checklist*:ti,ab OR Instrument*:ti,ab OR Interview*:ti,ab OR Inventory:ti,ab OR Measure*:ti,ab OR Questionnaire*:ti,ab OR ‘Recall’:ti,ab OR Record*:ti,ab OR Screen*:ti,ab OR Self-report*:ti,ab OR Survey*:ti,ab OR Tool*:ti,ab)) OR ‘Physical Frailty Phenotype’:ti,ab,kw OR ‘Deficit Accumulation Index’:ti,ab,kw OR ‘Gill Frailty Measure’:ti,ab,kw OR ‘Clinical Frailty Scale’:ti,ab,kw OR ‘Winograd Screening Instrument’:ti,ab,kw OR ‘Brief Frailty Instrument’:ti,ab,kw OR ‘FRAIL Scale’:ti,ab,kw OR ‘Vulnerable Elders Survey’:ti,ab,kw OR ‘NSQIP-FI’:ti,ab OR ‘Edmonton Frail Scale’:ti,ab,kw OR (NSQIP:ti,ab AND (‘frail’:ti,ab OR ‘fraility’:ti,ab)))

Scopus

TITLE-ABS-KEY (“gynecology” OR “gynecologic” OR “vagina” OR “vaginal” OR “uterus” OR “uterine” OR “cervix” OR “cervical” OR “ovary” OR “ovarian” OR “ovaries” OR “vulva” OR “pelvic floor disorder” OR “pelvic floor disorders” OR “pelvic floor dysfunction” OR “endometriosis” OR urogynecolog* OR “pelvic organ prolapse” OR “cystocele” OR “rectocele” OR “enterocele” OR “apical prolapse” OR “urogenital prolapse” OR “urinary bladder prolapse” OR “menopause” OR “menopausal” OR “Post menopause” OR “Post menopausal” OR “Postmenopause” OR “Postmenopausal” OR “Perimenopause” OR “Perimenopausal” OR “Premenopause” OR “premenopausal” OR “Adenomyosis” OR “Adnexal Diseases” OR “Anovulation” OR “Dyspareunia” OR “Endometrial” OR “Endometritis” OR “endometrium” OR “Fallopian Tube” OR “Fallopian tubes” OR “Gynatresia” OR “Hematocolpos” OR “Hematometra” OR “Hydrocolpos” OR “Menorrhagia” OR “Oophoritis” OR “Parametritis” OR “Pyometra” OR “Rectovaginal” OR “Salpingitis” OR “Vaginismus” OR “Vaginitis” OR “Vaginosis” OR “Vesicovaginal” OR “Vulvitis” OR “Vulvodynia” OR “Vulvovaginal” OR “Vulvovaginitis” OR ((“Herpes” OR “Infertility” OR “Sexual Dysfunction” OR “Genital” OR “genitals” OR “Reproductive Tract Infections” OR “Reproductive Tract Infection” OR “Sexually Transmitted Diseases” OR “Sexually Transmitted Diseases” OR “STD” OR “STDs”) AND (“female” OR “females” OR “women” OR “woman”)) OR “female genitalia” OR “urinary incontinence” OR “stress urinary incontinence” OR “mixed urinary incontinence” OR “urgency incontinence” OR “overactive bladder” OR “nocturia” OR “urinary urgency” OR “urinary frequency” OR “Brenner Tumor” OR “Cancer of Endometrium” OR “Cancer of the Uterus” OR “Cancer of Uterus” OR “Cervical Cancer” OR “Cervical Cancers” OR “Cervical Neoplasm” OR “Cervical Neoplasms” OR “Cervix Cancer” OR “Cervix Neoplasm” OR “Cervix Neoplasms” OR “Endometrial Cancer” OR “Endometrial Cancers” OR “Endometrial Carcinoma” OR “Endometrial Carcinomas” OR “Endometrial Neoplasm” OR “Endometrial Neoplasms” OR “Endometrium Cancer” OR “Endometrium Cancers” OR “Endometrium Carcinoma” OR “Endometrium Carcinomas” OR “Female Genital Neoplasm” OR “Female Genital Neoplasms” OR “Granulosa Cell Tumor” OR “Gynecologic Neoplasm” OR “Gynecologic Neoplasms” OR “Luteoma” OR “Meigs Syndrome” OR “Ovarian Cancer “OR “Ovarian carcinoma” OR “Ovarian Neoplasms” OR “Thecoma” OR “Uterine Cancer” OR “Uterine Cancers” OR “Uterine Cervical Neoplasms” OR “Uterine Neoplasm” OR “Uterine Neoplasms” OR “Uterus Cancer” OR “Uterus Cancers” OR “Uterus Neoplasm” OR “Uterus Neoplasms” OR “Vaginal Neoplasms” OR “Vulvar Neoplasms” OR “Cervix cancers” OR “Endometrial Ablation” OR “Endometrial Ablations” OR “Endometrium ablations” OR “Endometrium ablation” OR “Endometrial resection” OR “Endometrium resection” OR “Endometrial resections” OR “Endometrium resections” OR “Hysterectomy” OR “hysterectomies” OR “colpohysterectomy” OR “hysterocolpectomy” OR “panhysterectomy” OR “colpectomy” OR “Colpocleisis” OR “Sacrocolpopexy” OR “Colpopexy” OR “Anterior repair” OR “anterior colporrhaphy” OR “posterior repair” OR “posterior colporrhaphy” OR “perineoplasty” OR “perineorrhaphy” OR “mid-urethral sling” OR “transobturator tape” OR “incontinence sling” OR “supervaginal amputation” OR “total hysterectomy” OR “uterus amputation” OR “uterus extirpation” OR “Colpohysterectomy” OR “Colpohysterectomies” OR “Trachelectomies” OR “Cervicectomy” OR “Cervicectomies” OR “Trachelectomy” OR “Hysteroscopic “OR “Hysteroscopies” OR “Hysteroscopy” OR “Uterine Endoscopies” OR “Uterine Endoscopy” OR “Uteroscopies” OR “Uteroscopy” OR “Oophorectomies” OR “Oophorectomy” OR “oophorotomy” OR “ovarectomy” OR “Ovariectomies” OR “Ovariectomy “OR “ovariotomy” OR “ovarotomy” OR “ovary resection” OR “Salpingo-oophorectomy” OR “Salpingo oophorectomy” OR “Salpingo oophorectomies” OR “salpingooophorectomy” OR “salpingooophorectomies” OR “uterine adnexectomy” OR “salpingo ophorectomies” OR “salpingo ophorectomy” OR “salpingectomia” OR “Salpingectomy” OR “Salpingectomies” OR “Tubectomy” OR “Tubectomies” OR “Tubal Excision” OR “Tubal Excisions” OR “Salpingostomy” OR “Salpingostomies” OR “Aldridge Procedure” OR “Cooke Method” OR “Cornual Coagulation” OR “Cornual Coagulations” OR “Fimbriectomies” OR “Fimbriectomy” OR “Irving Method” OR “Kroener Fimbriectomy” OR “Kroener Method” OR “Madlener Method” OR “Pomeroy Method” OR “Pomeroy Sterilization” OR “Tubal Ligation” OR “Tubal Ligations” OR “Tubal Occlusion” OR “Tubal Occlusions” OR “Tubal Ring” OR “Tubal Rings” OR “Tubal Sterilization” OR “Tubal Sterilizations” OR “Tube Sterilization” OR “Tube Sterilizations” OR “tubal sterilization” OR “tubal sterilizations” OR “tube sterilization” OR “tube sterilizations” OR “Uchida Method” OR “Myomectomy” OR “Myomectomies” OR “Fibroidectomy” OR “Fibroidectomies” OR “Myomatectomy” OR “myomotomy” OR “Myomatectomies” OR “myomotomies”)

AND

TITLE-ABS-KEY (((“frail” OR “frailty” OR “prefrail” OR “pre frail” OR “prefrailty” OR “pre frailty” OR “frailities”) AND (Assess* OR Checklist* OR Instrument* OR Interview* OR Inventory OR Measure* OR Questionnaire* OR “Recall” OR Record* OR Screen* OR Self-report* OR Survey* OR Tool*)) OR “Physical Frailty Phenotype” OR “Deficit Accumulation Index” OR “Gill Frailty Measure” OR “Clinical Frailty Scale” OR “Winograd Screening Instrument” OR “Brief Frailty Instrument” OR “FRAIL Scale” OR “Vulnerable Elders Survey” OR “NSQIP-FI” OR “Edmonton Frail Scale” OR (NSQIP AND (“frail” OR “fraility”))).