The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape

Abstract

Introduction: Stress urinary incontinence (SUI) has an incidence of 15–80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. Aims: To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. Materials and methods: A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (n = 443): patients with ASA I risk. GB (n = 306): patients with ASA II risk. GC (n = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student’s t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for p < 0.05. Results: Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m2 (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (p = 0.0221) and GA (10.51%) (p = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. Conclusions: Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.

Optimizing Perioperative Fluid Management in Complex Abdominal Wall Reconstruction to Prevent Postoperative Acute Kidney Injury

“…ASA(American Society of Anesthesiologist) classification is used to calculate preoperative fitness, and has been demonstrated to be an acceptable surrogate for functional status. 10,11 Functional status is defined as decreased with an ASA class greater than 2 per ASA. All reconstructions included in this study were performed by a two-surgeon team at a single institution, a general surgeon who performed exploratory laparotomy, lysis of adhesions, and any indicated bowel resection and repair, and a plastic surgeon who performed the musculofascial abdominal core reconstruction, including placement of mesh and management of skin and soft tissue.…”

The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review

“…An observational study involving 6185 patients revealed a higher prevalence of urinary incontinence in cases with IADL dependence. 41 Eastern Cooperative Oncology Group performance status (ECOG-PS) 42,43 and American Society of Anesthesiologists physical status (ASA-PS) [44][45][46] are well-known measures of physical function that can influence the risk of postoperative complications and chemotherapy toxicity. 47 ASA-PS correlates with functional recovery after surgical treatment for female urinary incontinence with transobturator suburethral tape.…”

“…47 ASA-PS correlates with functional recovery after surgical treatment for female urinary incontinence with transobturator suburethral tape. 46 The VES-13, endorsed for older cancer patients undergoing chemotherapy in ASCO guidelines, 33 is a screening tool assessing physical function from various aspects through patient-based questions. In urology, a study showed that high VES-13 scores (indicating poor physical function) are correlated with longer hospital stays and more complications after surgery.…”

“…Eastern Cooperative Oncology Group performance status (ECOG‐PS) 42,43 and American Society of Anesthesiologists physical status (ASA‐PS) 44–46 are well‐known measures of physical function that can influence the risk of postoperative complications and chemotherapy toxicity 47 . ASA‐PS correlates with functional recovery after surgical treatment for female urinary incontinence with transobturator suburethral tape 46 . The VES‐13, endorsed for older cancer patients undergoing chemotherapy in ASCO guidelines, 33 is a screening tool assessing physical function from various aspects through patient‐based questions.…”