Hypothesis / aims of study
INTRODUCTION:
Functional recovery is the physical recovery and functional progression of everything affected by an injury, being a fundamental element for returning to work or daily activity in the best possible conditions, safely and painlessly (1). Post-operative recovery is complete when functionality is restored and symptoms disappear. Functional recovery after surgery can be assessed by both the physician and the patient, taking into account hospital stay, complications and early organ dysfunction (1).
OBJECTIVES: Know the factors that influence functional recovery and return to routine life after surgical correction of the cystocele.
Study design, materials and methods
A multicenter retrospective study of 1000 women operated on cystocele. Groups according to American Society of Anesthesiologists (ASA) physical status classification system (ASA): GA (n = 324): ASA-I, GB (n = 534): ASA-II, GC (n = 142): ASA-III. Variables: age, BMI, evolution and follow-up time, secondary diagnoses (DDSS), surgical history, complications that influence functional recovery after the intervention: bleeding, pain, and infection. Descriptive statistics, ANOVA analysis, Student's t-test, Fisher's exact test, multivariate analysis, p <0.05 was considered significant.
Results
Middle age 63a (30-87), lower in ASA-I (58a) and older in ASA-III (70a). Positive age recovery relationship in ASAI, and (-) in ASAII and ASA-III. Relationship BMI-positive functional recovery time in ASA-I, II and III. DDSS: ASA-II: there is more arterial hypertension (26.2%), Mellitus diabetes non-insulin dependent (6.56%), gastritis (10.29%), dyslipidemia (17.79%), hypothyroidism (10.29%) and depression (8.42%). In ASA-III plus ischemic heart disease (3.52%) and anxiety (21.12%). ASA-II: more abdominal and pelvic interventions. ASA-II: more interventions of pelvic floor and hysterectomies, normal delivery, dystocic delivery, and abortions. Higher number of DDSS in ASA-III. Complications: no differences in bleeding. More pain in ASA-III than ASA-I. More infection in ASA-II and III. In ASA-III there was more pain and infections, with an impact on functional recovery. Functional recovery in case of any complications: ASA-I: 5.31 days, ASA-II: 6.05 days; ASA-III: 6.09 days. Without complications, ASA-I recovered before ASA-II and ASA-III.
Main complications: Bleeding: ASA-I recovered in 6 days, before ASA-II (10.38) or ASA-III (14 days). Pain: ASA-II took longer in functional recovery (62.76 days) compared to ASA-I (13.6) or ASA-III (50 days). Infection: ASA-III took longer to recover (10.66 days) followed by ASA-II (9.76) and ASA-I (7.2).
Interpretation of results
The highest age is found in the ASA III group, which was 70 years old, with an average of 73, with a range of 48-80 and an Sd of 7.36. In other studies, it was found that the highest percentage of patients was in the age group over 60 years, which coincides with our results (2).
In relation to age and recovery time, the correlation between the two is positive, but practically flat, with a p = 0.0001. In the ASAII and ASA III groups, the correlation of age and recovery time was negative, that is, the older the child, the shorter the recovery time. In other studies, they find that age is not a predisposing factor for diseases of the pelvic floor (3). In our study, age was not a factor related to recovery time in relation to the fundamental anesthetic variable, which is the anesthetic risk ASA.
Concluding message
10% of patients present a complication related to the intervention of cystocele (bleeding, pain or infection) that delays the return to work life. In the case of complications, age is not related to recovery time, while BMI does. Average in re-turning to usual activity if there are complications: 8.93 days, higher than if there are none: 5.8 days. Pain is the factor that delays functional recovery the most, being of worse control in patients of ASA-II compared to ASA-III or ASA-I.