Late-breaking paper presented at AUGS/IUGA scientific meeting
Restrictions on activity and lifting after pelvic reconstructive surgery are traditionally recommended for patients. That practice was challenged by investigators at Duke University, led by former Duke urogynecology and reconstructive pelvic surgery fellow Michele O’Shea, MD, MPH, who conducted the Expedited Versus Restrictive: Limitations on Activity Following Surgical Treatment of Prolapse (EVeRLAST) Study.
Findings were presented at the 2022 American Urogynecologic Society (AUGS)/International Urogynecological Association (IUGA) scientific meeting in June 2022 as a late-breaking abstract titled “Standard Restrictions Versus Expedited Activity after Pelvic Organ Prolapse Surgery: A Randomized Non-inferiority Trial.”
The objective of the study was to determine whether expedited resumption of postoperative activity was noninferior to standard activity restrictions with respect to three-month anatomic and symptomatic outcomes in women undergoing surgery for pelvic organ prolapse. The investigators hypothesized that immediate resumption of physical activities as tolerated after prolapse surgery would result in noninferior anatomic support and symptomatic outcomes compared to standard restrictions.
One hundred and twenty three physically active patients with bothersome pelvic organ prolapse undergoing either vaginal or robotic surgery were randomized to either standard activity restrictions or expedited postoperative activity restrictions. Those randomized to standard restrictions were instructed to avoid heavy lifting over 10 pounds for six weeks and not return to work for at least two weeks for sedentary work, or six weeks for those with jobs that included physical labor. Participants randomized to expedited activity were told that they had no lifting or activity restrictions and that they should resume normal activity, including exercise, as soon as they were able.
The primary outcomes of the study included both anatomic (maximum extent of prolapse during straining) and symptomatic (measured using the 16-item Pelvic Organ Prolapse Distress Inventory) outcomes at three months. Other quality of life and activity measures were collected, including having each participant wear an activity monitor for six weeks after surgery.
Results of the study demonstrated both anatomic and symptomatic outcomes in patients with expedited activity after surgery were not inferior to those with standard activity and lifting restrictions. Based on these results, “It is reasonable for providers to instruct patients to resume physical activity ad lib after prolapse surgery,” said Dr. O’Shea. “Patients who resumed activity right away after surgery did just as well as those who were told to avoid lifting or activity for six weeks.”
The investigators intend to continue to follow the study patients for two years after surgery.
Matthew Barber, MD, MHS, senior author, noted, “This study is a paradigm shift for urogynecologists — it is practice changing. For decades, surgeons have been instructing patients to avoid activity after reconstructive surgery,and we now know that is unnecessary. The findings of this study are consistent with trials in other fields, like orthopedics and hernia surgery, which have shown that early activity doesn’t impede outcomes and may improve them in some circumstances.”
Study authors are Michele O’Shea, MD, MPH (fellowship Class of 2022); Tracy Truong, MS; Alaattin Erkanli, PhD; Nazema Siddiqui, MD, MHSc; and Matthew Barber, MD, MHS. This study was funded by the E.C. Hamblen Endowed Professorship fund of the Duke University School of Medicine.