Return to Baseline Activity Following Vaginal Pelvic Organ Prolapse Repair

INTRODUCTION: Counseling regarding recovery time following vaginal native tissue prolapse repair varies, and data regarding the time course of postoperative recovery are lacking. OBJECTIVE: To determine the time course of recovery following vaginal native tissue prolapse repair and identify factors impacting recovery. We hypothesized that approximately half of all patients would return to baseline by 6 weeks, and that age, concurrent hysterectomy, urinary retention, and baseline activity level would be associated with time to recovery. METHODS: This is a secondary analysis of a previously published randomized controlled trial of preoperative pelvic floor injections for pain control after vaginal surgery. Women aged ≥18 years undergoing vaginal native tissue prolapse repair (uterosacral ligament suspension, sacrospinous ligament fixation, or obliterative surgeries with and without hysterectomies) under general anesthesia were included. Perioperative management followed a standardized enhanced recovery after surgery protocol. The Activities Assessment Scale (AAS), previously validated in the urogynecology population, was used to quantify perioperative functional status. Our primary outcome was the proportion of participants returning to baseline activity at 6 weeks. We also assessed the proportion of participants who returned to baseline activity at 1, 2, and 12 weeks and whether any demographic or perioperative factors were associated with return to baseline. Chi-square, Fisher exact test, and logistic regression analysis were used as appropriate. RESULTS: Seventy-five participants with a mean age of 69.1 ± 11.1 years and mean BMI of 27.5 ± 4.2 kg/m2 were included (Table 1). The majority were White (89.3%), non-Latinx (96.0%), and with Medicare insurance (68%). The most common apical prolapse procedure was obliterative vaginal surgery (58.7%), followed by uterosacral ligament suspension (30.7%) and sacrospinous ligament fixation (10.7%) (Table 2). Half (50.7%) had a concomitant hysterectomy. Most patients (82.7%) were discharged on postoperative day 0, and half (50.7%) were discharged with either an indwelling catheter or intermittent self-catheterization. Over half (52.3%) of all patients returned to their baseline activity by 1 week postoperatively, with 69.2% and 84.4% returning to baseline activity by 2 and 6 weeks, respectively. Nearly all patients (93.8%) had returned to baseline by 12 weeks. On univariate analysis, COPD was negatively associated with return to baseline activity by 6 weeks (OR 15.67, 95% CI 1.23–199.92, p=0.03). However, on multivariate logistic regression including candidate variables (p<0.2), no factors were significantly associated with return to activity. Neither age, concurrent hysterectomy, prolapse procedure, operative time, postoperative urinary retention, nor postoperative pain scores was significantly associated with return to baseline activity by 6 weeks. Similar results were obtained when examining 2-week recovery. CONCLUSIONS: Contrary to traditional counseling of a 4–6-week recovery after vaginal prolapse surgery, we found that more than two-thirds of patients had returned to their preoperative level of activity within 2 weeks. Notably, factors that we hypothesized would impact postoperative recovery, including age, concomitant hysterectomy, and urinary retention, were not associated with return to baseline activity. These data can help guide preoperative counseling and suggest that surgical recovery, even in an older postmenopausal population, is likely quicker than previously supposed.