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Survey of Postoperative Activity Guidelines After Minimally Invasive Gynecologic and Pelvic Reconstructive Surgery

Winkelman, William D., MD*†‡; Erlinger, Adrienne L., MPH†‡; Haviland, Miriam J., MSPH†‡; Hacker, Michele R., ScD†‡; Rosenblatt, Peter L., MD*†‡

Female Pelvic Medicine & Reconstructive Surgery: January 30, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000697
Original Article: PDF Only
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Objective(s) Most surgeons recommend restriction of activities after minimally invasive gynecologic and pelvic reconstructive surgery. The goal of this study was to identify and assess the postoperative guidelines gynecologists and urogynecologists provide their patients.

Methods This was a cross-sectional study of physicians at a national gynecology conference in March 2018. Respondents were asked to answer questions about the typical postoperative recommendations they provide patients after gynecologic surgery as well as their postoperative prescribing habits.

Results There were 418 attendees, and 135 (32%) eligible physicians completed the survey. Of respondents, 87% were specialists in female pelvic medicine and reconstructive surgery. Most respondents (61%) were in academic practice. Most respondents (82%–86%) recommended specific postoperative lifting restrictions, and 49% to 52% recommended limiting lifting to a maximum of 10 lb after surgery with some variation depending on the surgical procedure performed. Many respondents (42%–56% depending on the surgical procedure) recommended that patients wait at least 2 weeks before returning to sedentary work. Male respondents and those who were in practice for more than 10 years recommended that patients return to work sooner compared with those who were in practice less than 10 years. Male respondents prescribed fewer opioids to patients after vaginal hysterectomy (P = 0.04) and vaginal prolapse repair (P = 0.03) compared with female respondents.

Conclusions After minimally invasive gynecologic or pelvic reconstructive surgery, providers recommend a wide range of postoperative restrictions and prescribe significantly different quantities of opioids during the postoperative period. This study highlights some of the recommendations with the greatest variability.

From the *Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge;

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center; and

Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA.

Correspondence: William D. Winkelman, MD, Boston Urogynecology Associates, 725 Concord Ave, Suite 1200, Cambridge, MA 02138. E-mail: william.winkelman@mah.harvard.edu.

The authors have declared they have no conflicts of interest.

This work was conducted with support from Harvard Catalyst|The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic health care centers, or the National Institutes of Health.

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