Time to Physical Recovery After Minimally Invasive Sacral Colpopexy

INTRODUCTION: There is a growing body of evidence showing that physical activity restrictions after surgery for pelvic organ prolapse (POP) are not evidence based and largely antiquated. Objective data describing the time to recovery of physical activity after specific procedures for POP are sparse. OBJECTIVE: To describe the recovery of physical activity in women undergoing minimally invasive sacral colpopexy using accelerometer data. METHODS: Women undergoing laparoscopic or robotic sacral colpopexy, with or without concomitant hysterectomy, were eligible for this study if they had surgery between 07/01/2024 and 08/27/2025. They were included if they were willing to use a wrist-worn accelerometer (Actigraph GT3X+) for 1 week prior to surgery and for the 4 weeks immediately following surgery. Patients undergoing concomitant posterior repair with or without perineorrhaphy were excluded. For all patients with valid wear time (1), physical activity data (step counts, time in total non-sedentary physical activity, and time in light versus moderate/vigorous activity) were averaged by week during a preoperative baseline period and for weeks 1 through 4 postoperatively. Recovery in each category of physical activity was determined as a percentage of baseline during weeks 1–4. Subjective patient-reported physical activity status was also reported using the Activities Assessment Scale (AAS) (2) at baseline. The AAS and the Post-Op Recovery Question (PORQ) were collected postoperatively at the end of weeks 2 and 4. The PORQ asks to what degree patients feel physically recovered from surgery, and the answers, 1–5, indicate 0%, 25%, 50%, 75%, or 100% recovered. Those reporting 75–100% were considered “Recovered.” Physical activity data was compared to PORQ answers at weeks 2 and 4, and correlation was assessed using the Pearson correlation coefficient. RESULTS: Of 34 patients enrolled in the study, 28 had valid wear time during the baseline week and at least 3 consecutive weeks postoperatively. Patient medical, surgical, and demographic data are shown in Table 1. None of the enrolled patients spent any time in vigorous activity during the recorded baseline or postoperative visits. Table 2 reveals recovery of baseline physical activity parameters, AAS scores, and PORQ by postoperative week. AAS total and subscale scores recovered to 85–96% of baseline within 1 week. At 2 and 4 weeks, 47% and 85% felt recovered, respectively. There were no differences in accelerometer-recorded activity parameters between patients who did and did not feel recovered, and there were no statistically significant correlations between PORQ answers and physical activity at any time point. CONCLUSIONS: Physical activity recovery after minimally invasive sacral colpopexy progresses over 4 weeks, with time in total and light activity returning to baseline within 1 week. Moderate activity and step counts recover more slowly but return to baseline by week 4. These latter parameters mimic patient-reported recovery, which occurs in about half of patients by 2 weeks and 85% by week 4.Table 1Table 2