Postoperative Challenges of Older Women Undergoing Prolapse Surgery: A Qualitative Analysis

Objectives: In the United States, women have a 13% lifetime risk of undergoing surgery for pelvic organ prolapse (POP). Although common, there is limited literature investigating the postoperative experiences of older patients surrounding POP surgery. Understanding what challenges patients perceive during the immediate postoperative period may improve preoperative counseling and anticipatory guidance following discharge.

The aim of this study is to explore the immediate postoperative experiences of older women who underwent POP surgery to describe the most challenging aspects of their recovery.

Methods: We conducted qualitative, semi-structured telephone interviews with women previously enrolled in a prospective cohort study focused on perioperative neurocognitive disorders in women aged ≥60 years who underwent POP surgery between 2018-2019 at a large academic medical center. All interviews were transcribed verbatim and portions of interviews addressing the immediate postoperative experience were coded in an open, iterative fashion by 2 independent coders. After applying the codebook to all existing transcripts, we examined codes for patterns to identify categories and themes.

Results: To date, we have conducted interviews with 10 participants (ages 71-78 years) and interviews were conducted 1.7-2.3 years after POP surgery. Women often described the most challenging aspect of recovery as unanticipated, leading to emotional distress due to subverted expectations. In fact, several patients reported being well-informed prior to surgery on potential postoperative adverse events but did not personally expect to experience difficulties. Example recovery challenges included postoperative urinary retention requiring catheterization, varied responses to anesthesia, adjustment to postoperative activity restrictions, and dependence on others for activities daily of living, particularly in those women who self-identified as healthy or functionally independent at baseline.

Conclusions: With POP affecting up to half of older women, it is important to gain insight into potential barriers that could delay or impede a patient’s recovery. Older patients who underwent POP surgery describe challenges coping with changes and limitations in function in the immediate postoperative period. Understanding the nuances of these experienced challenges can inform counseling and planning preparation for post-operative recovery.