Models for predicting recurrence, complications, and health status in women after pelvic organ prolapse surgery

NICHD Pelvic Floor Disorders Network

Research output: Contribution to journalArticle

Abstract

Objective: To develop statistical models predicting recurrent pelvic organ prolapse, surgical complications, and change in health status 12 months after apical prolapse surgery. Methods: Logistic regression models were developed using a combined cohort from three randomized trials and two prospective cohort studies from 1,301 participants enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery. Complications were defined as any serious adverse event or Dindo grade III complication within 12 months of surgery. Significant change in health status was defined as a minimum important change of SF-6D utility score (±0.035 points) from baseline. Thirty-two candidate risk factors were considered for each model and model accuracy was measured using concordance indices. All indices were internally validated using 1,000 bootstrap resamples to correct for bias. Results: The models accurately predicted composite recurrent prolapse (concordance index=0.72, 95% CI 0.69-0.76), bothersome vaginal bulge (concordance index=0.73, 95% CI 0.68-0.77), prolapse beyond the hymen (concordance index=0.74, 95% CI 0.70-0.77), serious adverse event (concordance index=0.60, 95% CI 0.56-0.64), Dindo grade III or greater complication (concordance index=0.62, 95% CI 0.58-0.66), and health status improvement (concordance index=0.64, 95% CI 0.62-0.67) or worsening (concordance index=0.63, 95% CI 0.60-0.67). Calibration curves demonstrated all models were accurate through clinically useful predicted probabilities. Conclusion: These prediction models are able to provide accurate and discriminating estimates of prolapse recurrence, complications, and health status 12 months after prolapse surgery.

Original languageEnglish (US)
Pages (from-to)298-309
Number of pages12
JournalObstetrics and Gynecology
Volume132
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Pelvic Organ Prolapse
Prolapse
Health Status
Recurrence
Hymen
Pelvic Floor Disorders
Logistic Models
Retreatment
Statistical Models
Reoperation
Calibration
Cohort Studies
Prospective Studies

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Models for predicting recurrence, complications, and health status in women after pelvic organ prolapse surgery. / NICHD Pelvic Floor Disorders Network.

In: Obstetrics and Gynecology, Vol. 132, No. 2, 01.01.2018, p. 298-309.

Research output: Contribution to journalArticle

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abstract = "Objective: To develop statistical models predicting recurrent pelvic organ prolapse, surgical complications, and change in health status 12 months after apical prolapse surgery. Methods: Logistic regression models were developed using a combined cohort from three randomized trials and two prospective cohort studies from 1,301 participants enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery. Complications were defined as any serious adverse event or Dindo grade III complication within 12 months of surgery. Significant change in health status was defined as a minimum important change of SF-6D utility score (±0.035 points) from baseline. Thirty-two candidate risk factors were considered for each model and model accuracy was measured using concordance indices. All indices were internally validated using 1,000 bootstrap resamples to correct for bias. Results: The models accurately predicted composite recurrent prolapse (concordance index=0.72, 95{\%} CI 0.69-0.76), bothersome vaginal bulge (concordance index=0.73, 95{\%} CI 0.68-0.77), prolapse beyond the hymen (concordance index=0.74, 95{\%} CI 0.70-0.77), serious adverse event (concordance index=0.60, 95{\%} CI 0.56-0.64), Dindo grade III or greater complication (concordance index=0.62, 95{\%} CI 0.58-0.66), and health status improvement (concordance index=0.64, 95{\%} CI 0.62-0.67) or worsening (concordance index=0.63, 95{\%} CI 0.60-0.67). Calibration curves demonstrated all models were accurate through clinically useful predicted probabilities. Conclusion: These prediction models are able to provide accurate and discriminating estimates of prolapse recurrence, complications, and health status 12 months after prolapse surgery.",
author = "{NICHD Pelvic Floor Disorders Network} and Jelovsek, {J. Eric} and Kevin Chagin and Lukacz, {Emily S.} and Nolen, {Tracy L.} and Shepherd, {Jonathan P.} and Barber, {Matthew D.} and Vivian Sung and Linda Brubaker and Norton, {Peggy A.} and Rahn, {David D} and Smith, {Ariana L.} and Alicia Ballard and Peter Jeppson and Meikle, {Susan F.} and Kattan, {Michael W.}",
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T1 - Models for predicting recurrence, complications, and health status in women after pelvic organ prolapse surgery

AU - NICHD Pelvic Floor Disorders Network

AU - Jelovsek, J. Eric

AU - Chagin, Kevin

AU - Lukacz, Emily S.

AU - Nolen, Tracy L.

AU - Shepherd, Jonathan P.

AU - Barber, Matthew D.

AU - Sung, Vivian

AU - Brubaker, Linda

AU - Norton, Peggy A.

AU - Rahn, David D

AU - Smith, Ariana L.

AU - Ballard, Alicia

AU - Jeppson, Peter

AU - Meikle, Susan F.

AU - Kattan, Michael W.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To develop statistical models predicting recurrent pelvic organ prolapse, surgical complications, and change in health status 12 months after apical prolapse surgery. Methods: Logistic regression models were developed using a combined cohort from three randomized trials and two prospective cohort studies from 1,301 participants enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery. Complications were defined as any serious adverse event or Dindo grade III complication within 12 months of surgery. Significant change in health status was defined as a minimum important change of SF-6D utility score (±0.035 points) from baseline. Thirty-two candidate risk factors were considered for each model and model accuracy was measured using concordance indices. All indices were internally validated using 1,000 bootstrap resamples to correct for bias. Results: The models accurately predicted composite recurrent prolapse (concordance index=0.72, 95% CI 0.69-0.76), bothersome vaginal bulge (concordance index=0.73, 95% CI 0.68-0.77), prolapse beyond the hymen (concordance index=0.74, 95% CI 0.70-0.77), serious adverse event (concordance index=0.60, 95% CI 0.56-0.64), Dindo grade III or greater complication (concordance index=0.62, 95% CI 0.58-0.66), and health status improvement (concordance index=0.64, 95% CI 0.62-0.67) or worsening (concordance index=0.63, 95% CI 0.60-0.67). Calibration curves demonstrated all models were accurate through clinically useful predicted probabilities. Conclusion: These prediction models are able to provide accurate and discriminating estimates of prolapse recurrence, complications, and health status 12 months after prolapse surgery.

AB - Objective: To develop statistical models predicting recurrent pelvic organ prolapse, surgical complications, and change in health status 12 months after apical prolapse surgery. Methods: Logistic regression models were developed using a combined cohort from three randomized trials and two prospective cohort studies from 1,301 participants enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery. Complications were defined as any serious adverse event or Dindo grade III complication within 12 months of surgery. Significant change in health status was defined as a minimum important change of SF-6D utility score (±0.035 points) from baseline. Thirty-two candidate risk factors were considered for each model and model accuracy was measured using concordance indices. All indices were internally validated using 1,000 bootstrap resamples to correct for bias. Results: The models accurately predicted composite recurrent prolapse (concordance index=0.72, 95% CI 0.69-0.76), bothersome vaginal bulge (concordance index=0.73, 95% CI 0.68-0.77), prolapse beyond the hymen (concordance index=0.74, 95% CI 0.70-0.77), serious adverse event (concordance index=0.60, 95% CI 0.56-0.64), Dindo grade III or greater complication (concordance index=0.62, 95% CI 0.58-0.66), and health status improvement (concordance index=0.64, 95% CI 0.62-0.67) or worsening (concordance index=0.63, 95% CI 0.60-0.67). Calibration curves demonstrated all models were accurate through clinically useful predicted probabilities. Conclusion: These prediction models are able to provide accurate and discriminating estimates of prolapse recurrence, complications, and health status 12 months after prolapse surgery.

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