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Perioperative Assessment in the Older Woman Undergoing Pelvic Floor Surgery

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Abstract

Purpose of Review

This review aims to summarize the data currently available on perioperative issues pertinent to the aging adult to help provide a resource for surgical caregivers.

Recent Findings

Older adults can safely undergo pelvic surgery and expect improvements in their quality of life. Preoperative evaluation may need to consider an individual’s risk based on their medical comorbidities and baseline functional status, rather than age alone. Frailty has been identified as an important factor when determining a patient’s risk of complications from pelvic floor surgery and their expected course of recovery.

Summary

Access to improved healthcare has led to an aging population that presents unique challenges to medical providers. These challenges impact surgical outcomes and are particularly important for specialties more likely to care for older patients, such as Urogynecology and Reconstructive Pelvic Surgery. Normal age-related physiologic changes, polypharmacy, and a decline in functional status all may inhibit optimal postoperative outcomes. Alterations in organ systems may make aging adults more susceptible to complications from both medications and surgery. The older patient is also at risk for cognitive impairment and frailty concerns, which have been shown to impact surgical recovery. Providers may need to familiarize themselves with these conditions and the general changes seen in the aging adult to help improve patient outcomes. Validated questionnaires and tools are available for time-efficient screening of conditions that may require further optimization prior to surgery.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Joy E. Wheat

  2. Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    Donna Mazloomdoost

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Correspondence to Donna Mazloomdoost.

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Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors were performed in accordance with all applicable ethical standards including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

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Appendix 1

Human and Animal Rights and Informed Consent: All reported studies/experiments with human or animal subjects performed by the authors were performed in accordance with all applicable ethical standards including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

Timed Up and Go Test (TUG)

Identify a point 3 m, or 10 feet, away on the floor. The patient can wear their regular footwear, use a mobility aid if needed. The patient should be seated in a standard armchair. Instruct the patient that when you say ‘Go’, they should stand up from the chair and walk to the designated point at their normal pace. Once they reach that point, turn around, walk back to the chair at a normal pace and sit down again. On the word ‘Go’, begin timing, and stop after the patient sits back down. Less than 10 s to complete is normal, and frail is 15 s or more.

Life Space Assessment (LSA)

Each LSA level has a score (1–5), which is multiplied by the frequency and independence of each activity. The scores are then summed for all five levels and range from 0 to 120 with a score below 60 being indicative of a restricted life space.

LSA Mobility Level (1–5) x Frequency x Independence = Row Total

Mobility Level.

Level 1: Beyond room in which one sleeps (1 pt).

Level 2: Outside of home such as a porch or hallway (2 pt).

Level 3: Outside of home but within neighborhood (3 pt).

Level 4: Outside of neighborhood but within one’s town (4 pt).

Level 5: Outside of town (5 pt).

Frequency Score.

Less than 1 per week: 1 pt.

1-3 times per week: 2 pt.

4-6 times per week: 3pt.

Daily: 4 pt.

Independence Score.

Needed personal assistance: 1 pt.

Needed equipment alone: 1.5 pt.

No personal help or equipment: 2 pt.

Referenced from Peel C, Sawyer Baker P, Roth DL, Brown CJ, Brodner EV, Allman RM. Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment. Phys Ther. 2005;85(10):1008–1119.

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Wheat, J.E., Mazloomdoost, D. Perioperative Assessment in the Older Woman Undergoing Pelvic Floor Surgery. Curr Geri Rep 12, 75–84 (2023). https://doi.org/10.1007/s13670-023-00392-6

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