Impact of Caregivers on Postoperative Recovery after Major Pelvic Organ Prolapse Surgery.

Objectives: To determine the impact of caregivers on the postoperative convalescence of patients who undergo same day discharge (SDD) after major pelvic organ prolapse (POP) repair surgery. The secondary aim was to report the caregiver characteristics in this cohort.

Methods: This was a prospective cohort study design with patients enrolled from May 2021 through September 2022. Patients were eligible if they underwent SDD to their home after major POP repair surgery. Patients were administered questionnaires on postoperative days (POD) 3, 7, 14, and 28. Questionnaires included two validated postoperative recovery questionnaires in which higher score corresponds to better recovery (Quality of Recovery 15 [QOR15], Post-discharge Surgical Recovery Scale 13 [PSR13]). Additional questionnaire about caregiver factors and interactions was also administered. The patient’s primary support person during their surgery was designated as their caregiver.

Results: The final analysis included 100 patients who were on average 63 ± 10.3 years-old, with a mean body mass index of 26.8 ± 4.6 kg/m². Most patients reported regular baseline activity (n=84) and lived with a spouse/partner (n=65). A minority of patients reported that they lived alone (n=11). The caregivers were most commonly a spouse/partner (n=52), male (n=61), with an average age of 51 ± 18 years old. Most caregivers had no prior experience assisting with postoperative recovery (n=69) and were employed (n=73). Caregivers were present daily through POD3 for 87% of patients and through POD28 for 79% of patients. Daily caregiver presence through POD3 was used to define the cohorts for further analysis. Compared to the cohort with daily caregiver presence (n=87), the cohort without a daily caregiver (n=13) was more likely to have American Society of Anesthesiologists Classification 3 (46.2 vs 19.5%, p=0.03), lower parity, and was less likely to have a spouse as a caregiver (0 vs 59.8%, p < 0.001). Overall, mean PSR13 and QOR15 scores increased over time from POD3 to POD28 (PSR13: 59.7 to 89.1; QOR15: 131 to 148). No statistically significant differences in the PSR13 or QOR15 scores were noted between the cohorts. On multivariable analysis controlling for select caregiver and patient variables, the PSR13 and QOR15 scores did not differ between the two cohorts at any time points based on caregiver presence (p>0.37). However, the caregiver relationship with the patient was significantly associated with PSR13 scores. Specifically, non-family/spouse caregivers were associated with lower PSR13 scores (p < 0.01). Increasing age was associated with lower QOR15 scores.

Conclusions: Most patients undergoing major POP surgery had caregivers present daily during their postoperative recovery. Recovery course as measured by two validated questionnaires did not differ between patients who had caregivers present daily versus those who did not. This information can be used for setting postoperative patient and caregiver expectations.