Scoping review of evidence-based postoperative recommendations following urogynecology surgery

Background: Most gynecology and urogynecology surgeons recommend restrictions that include pelvic rest as well as activity and lifting restrictions in the immediate postoperative period. The objective of this review is to summarize the literature on these postoperative restrictions and their health outcomes and surgical success. In addition, we aim to give evidence-based recommendations in the key areas of postoperative care. Methods: We conducted a comprehensive search to identify studies discussing post-operative restrictions and recommendations after urogynecologic and benign minimally invasive gynecologic surgery. Searches were conducted in the PubMed and the Cochrane Library (1996 to 2023). Results: There is limited prospective data evaluating the role of postoperative activity restriction in benign gynecologic surgery or pelvic reconstructive surgery outcomes and long-term data (>12 months data) is even more scarce. Short-term outcomes including patient satisfaction, anatomic success and complications supports less restriction. Current evidence supports early ambulation, screening for postoperative urinary retention and early advancement in diet to return to bowel function. Conclusions: The current evidence does not support postoperative physical activity restrictions following gynecologic surgery, but more research is needed to fully understand the long-term implications of eliminating these restrictions. The next step in optimizing the postoperative recovery period is research looking at an active recovery similar to what is commonly seen in orthopedic surgery.