Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up.

OBJECTIVE

This study was undertaken to describe long-term postoperative perceived achievement of subjective preoperative goals for pelvic floor dysfunction (PFD) surgery.

STUDY DESIGN

From March 2000 through December 2001, 123 PFD surgical patients completed a preoperative open-ended questionnaire on which they described up to 5 personal outcome goals for PFD surgery. Patients were asked to review their original goals list and assess the degree to which they had met their goals on a 5-point scale (-2=strongly disagree the goal had been met to +2=strongly agree that the goal had been met) 3 months after surgery and again between 1 and 3 years after surgery. At the second follow-up, patients also completed the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) instruments to assess life impact and symptom distress, respectively.

RESULTS

Of 50 women to date with long-term follow-up, 98% were white, 96% had delivered at least 1 child, 38% had previous surgery for PFD, mean weight was 74.2 +/- 14.1 kilos, and mean age was 65.4 +/- 11.5 years. Mean follow-up duration was 1.8 years, and ranged from 0.98 to 3.01 years. Of 194 goals listed by participants, 40.2% had to do with resuming previous activities or lifestyle, 38.1% with symptom relief, 9.3% with improving self-image and social relationships, 7.7% with improving general health, and 4.6% with improving physical appearance. At the individual goal level, 72% of goals were attained at short-term, and 68% attained at long-term follow-up. Long-term goal achievement did not vary significantly by category of goal. Goal achievement was lower only for symptom relief at long-term follow-up (68.9%) than at short-term follow-up (87.4%, P <.001). At the person level, 45.8% of women reported achieving all listed goals in the short term, and 42.0% in the long term. Long-term goal achievement was associated with PFD-specific quality of life (UDI-6 and IIQ-7 scores) and inversely associated with surgical complications, but was not associated with other clinical or demographic variables, including weight, parity, PFD diagnosis, psychiatric comorbidity, surgical route, or previous surgical history.

CONCLUSION

Self-reported achievement of preoperatively recorded goals for PFD surgery persisted 1 to 3 years after surgery. The association of goal achievement to IIQ-7 and UDI-6 scores suggests that goal achievement is related to, but not identical to, overall measures of PFD life impact and symptom distress. Future work should examine the association of goal achievement to clinical measures of PFD severity, and compare surgically and medically managed patients. Preoperative assessment of goals may be a useful addition to clinical and subjective data in the long-term management of women with pelvic floor disorders.