Functional Improvement With Abdominoplasty
Condition: Lower Back Pain Chronic; Urinary Incontinence; Recti Diastasis; Abdominoplasty
MeSH terms: Urinary Incontinence; Enuresis; Back Pain; Low Back Pain
Study type: Observational

Summary: 
      The study investigates the impact of abdominoplasty in the post partum population on the
      symptoms of back pain and urinary incontinence. Patients presenting for abdominoplasty fill
      out validated questionnaires for both back pain (Oswestry Disability Index) and urinary
      incontinence (ICIQ-UI short form). They complete the same questionnaires 6 weeks and 6 months
      post op. The prospectively gathered data gives an insight into the incidence of functional
      symptoms in this post partum group preop as well as the degree of improvement gained postop.
      This is a multicenter trial with 9 surgeons submitting patients to the study, which ran for
      19 months.
    

Detailed description: 
      Abdominoplasty has long been considered a cosmetic procedure, improving the shape of the
      abdomen by excess skin removal, liposuction and rectus muscle plication. Performed chiefly on
      the post-partum and weight loss population, there have been reports of improvement in the
      functional symptoms of back pain and incontinence following abdominoplasty with rectus
      plication but there has been no prospective multicentre study to investigate the issue.

      The incidence of chronic back pain greater than two years following pregnancy has been
      reported between 5% to 21.1%. Persistent urinary incontinence rates 10 to 12 years after
      pregnancy range between 25% to 37.9%. Vaginal delivery is associated with a higher incidence
      of long term stress incontinence. The Australian female population is approximately 11m. With
      a 24% rate of childlessness up to 1.67m Australian women are suffering chronic back pain and
      3.2m stress incontinence. Both these conditions negatively affect the quality of life and are
      usually under reported.

      This is a multicentre prospective study on the impact of abdominoplasty on back pain and
      urinary incontinence in the post-partum population. All post-partum patients presenting for
      abdominoplasty were enrolled to give an indication of incidence of symptoms in this
      population as well as the magnitude of improvement or deterioration.

      The prospective study utilised validated questionnaires. For back pain the Oswestry
      Disability Index (ODI) was selected as it is an excellent measure of a patient's functional
      disability and has been in use for nearly 40 years. The Index is a multiple choice
      questionnaire, divided into 10 sections assessing Pain Intensity, Personal Care, Lifting,
      Walking, Sitting, Standing, Sleeping, Social Life, Travelling and the impact on Employment
      and House making. Each section is scored from 0 to 5, the maximum score is 50. The score is
      then doubled to become a percentage disability index. Urinary Incontinence was measured with
      the International Consultation On Incontinence Questionnaire - Urinary Incontinence - Short
      Form (ICIQ-UI-SF). This is also a multiple-choice questionnaire asking the patient to score
      the frequency of urine leakage, how much they think leaks and on a scale of one to ten how
      much it interferes with daily life. It is not a disability index like the Oswestry. A maximum
      score is 21 with urine leaking all the time, large amounts and interfering with life a great
      deal.

      Patients completed the questionnaires pre abdominoplasty and at 6 weeks and 6 months post
      operation. Demographic information was collected; Age, Parity, Age Range of Children (the
      years between the oldest and youngest), Method of Birth (Vaginal or Caesarean) and BMI
      preoperatively. Surgical data was also obtained; Method of Abdominoplasty, Weight Removed,
      Volume of Liposuction, Width of Diastasis and the presence of a Hernia. No data on
      postoperative complications was collected. Patients signed an informed consent form to
      participate after reading an information pamphlet and the study was approved by the ACT
      Health Human Research Ethics Committee.

      A presentation at the 37th Annual Australasian Society of Aesthetic Plastic Surgeons
      conference in August 2014 recruited surgeons to the study. Nine surgeons agreed to take part
      and were given packs of questionnaires, patient information brochures, consent forms,
      demographic forms and a surgeons information sheet. The nine participants were individual
      private practitioners, four from Sydney NSW and one each from Canberra ACT, Toowoomba QLD,
      Brisbane QLD, Gold Coast QLD and Newcastle NSW, a mix of capital city and smaller regional
      centres along the east coast of Australia.

      The objective was to study both the incidence of functional symptoms in the population
      presenting for abdominoplasty as well as the outcome. Study surgeons were instructed to enrol
      all post-partum abdominoplasty patients. Nulliparous weight loss patients were excluded as
      were males. The completed forms were posted back to the study author who compiled the
      results. Statistical analysis was performed by Datalytics (Bruce ACT).
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Any post partum female presenting for abominoplasty regardless of whether they have
        functional symptoms or not.