Ep. 108 Treating Urogynecologic Frailty: Perioperative Strategies for Surgeons with Dr. Mary Ackenbom

As our patients' age progresses, so should our definition of 'recovery'. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients. --- SYNPOSIS Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery. --- TIMESTAMPS 00:00 - Introduction02:18 - Dr. Ackenbom’s Journey to Urogynecology04:47 - Research on Brain Fog06:18 - Personal Support and Hobbies09:54 - Age vs Frailty in Surgery13:05 - Procedures with Perioperative Complexity16:11 - Counseling on Operative Risk20:10 - ERAS and Earlier Discharge23:35 - Patient Goals and Tradeoffs27:53 - Surgical Clearance and Preop Consults33:30 - Prehabilitation Basics36:24 - Minimally Invasive Surgery Benefits37:15 - Surgical Cognitive Complications with Age41:42 - Finding the Surgery Window46:05 - Cognitive and Frailty Screening50:01 - Guidelines for Perioperative Care52:52 - Future Research 54:07 - Conclusion --- RESOURCES Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgeryhttps://pubmed.ncbi.nlm.nih.gov/32827107/ ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patienthttps://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf