Objective: To assess the effect of Parkinson’s disease (PD) on outcomes of surgical management in women with pelvic floor dysfunction (PFD).

Background: PFD is more common amongst women with PD, yet underreported and under-treated, thereby identifying a key gap in care of women with PD.(1-3) Medical management with anticholinergic and beta-agonist drugs is often inadequate and/or causes serious adverse effects. Pelvic floor surgeries remain a viable option for symptom management. Hesitancy toward elective surgery in PD may stem from known peri- and post-operative risks, including motor fluctuations, drug interactions, psychiatric comorbidity, and worsening of non-motor symptoms, besides complications arising from prolonged hospital stay.(4, 5)

Method: Data for this retrospective cohort study was derived by querying the Nationwide Inpatient Sample (NIS) database between 2012 and 2016 to identify women who underwent pelvic floor surgery. The NIS is a stratified 20% sample of discharges from all U.S. hospitals. Diagnosis was extracted using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes. Inpatient mortality, length of stay (LOS) and discharge destination were identified. The non-parametric Mann-Whitney U test was used to compare quantitative variables and the Fischer exact test used for categorical variables. Age and Charlson Comorbidity Index values were used to create a matched cohort.

Results: A total of 526 women with (0.1%) and 404,758 without a diagnosis of PD underwent surgery for PFD. Median age of patients with PD was higher compared to non-PD counterparts (70 years vs 44 years, p<0.001) with higher median comorbid conditions in PD group (4 vs 0, p<0.01). Median LOS was longer in PD group (3 days vs 2 days, p<0.001) with lower rates of discharge to home (58% vs 92%, p=0.0005). Groups were comparable in mortality following surgery (0.8% vs 0.3%, p=0.076). In the matched cohort, there was no difference in LOS (p=0.708) or mortality (0.8% vs 2.1%, p=0.116). Discharge destinations varied slightly between groups with PD group more likely to be discharged to skilled nursing or other facility.

Conclusion: PD does not appear to increase the risk of worse outcomes in PFD surgery. Our analysis argues against surgical hesitancy to alleviate morbidity and enhance quality of life in women with PD.

References: 1. Sakakibara R, Uchiyama T, Yamanishi T, Kishi M. Genitourinary dysfunction in Parkinson’s disease. Mov Disord. 2010;25(1):2-12.
2. Sakakibara R, Shinotoh H, Uchiyama T, Sakuma M, Kashiwado M, Yoshiyama M, et al. Questionnaire-based assessment of pelvic organ dysfunction in Parkinson’s disease. Auton Neurosci. 2001;92(1-2):76-85.
3. Gupta A, LaFaver K, Duque KR, Lingaiah A, Meriwether KV, Gaskins J, et al. Pelvic Floor Health in Women with Parkinson’s Disease. J Parkinsons Dis. 2021;11(2):857-64.
4. Lenka A, Mittal SO, Lamotte G, Pagan FL. A Pragmatic Approach to the Perioperative Management of Parkinson’s Disease. Can J Neurol Sci. 2021;48(3):299-307.
5. Jämsen E, Puolakka T, Peltola M, Eskelinen A, Lehto MU. Surgical outcomes of primary hip and knee replacements in patients with Parkinson’s disease: a nationwide registry-based case-controlled study. Bone Joint J. 2014;96-b(4):486-91.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outcomes-of-surgical-management-of-pelvic-floor-dysfunction-in-women-with-parkinsons-disease/