Perioperative Complications of Surgery for Pelvic Organ Prolapse in the Elderly and Very Elderly

Chapman G1, Sheyn D1, Emily S1, El-Nashar S1, Mangel J1, Hijaz A1, Mahajan S1

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 255
Best Urogynaecology
Scientific Podium Session 14
Thursday 5th September 2019
09:45 - 10:00
Hall K
Surgery Pelvic Organ Prolapse Female Gerontology
1.University Hospitals Cleveland Medical Center
Presenter
G

Graham Chapman

Links

Abstract

Hypothesis / aims of study
In an increasingly aging population, the number of elderly patients undergoing elective surgical management of pelvic organ prolapse is likely to grow significantly.  Current data on this topic are primarily retrospective reviews of single-institution experiences.  The aim of this study is to compare the perioperative complications surrounding surgery for pelvic organ prolapse in the elderly and very elderly patient populations versus the younger population using a national surgical database.
Study design, materials and methods
The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent surgery for pelvic organ prolapse from 2010 to 2017 using current procedural terminology codes.  Those undergoing surgery for cancer were excluded.  Patients under age 65 were grouped as the index population and compared to those between ages 65-79, which were deemed the “elderly” population, and over age 80, which were considered the “very elderly” population.  We compared the elderly and very elderly groups to the index population using the chi-squared test for categorical variables and Student’s t-test for continuous variables.  The primary outcome was a composite of serious complications and mortality.  Serious complications included myocardial infarction or other cardiac event, renal failure, pneumonia, thromboembolism, stroke, sepsis or serious infection, wound dehiscence, bladder or bowel injury, blood transfusion, reoperation, readmission, reintubation after surgery, non-home discharge, and mortality within 30 days of surgery.  Stepwise backward multivariate logistic regression was used to control for confounders and identify associations with the primary outcome.  Confounding variables were selected based on significance in univariate logistic regression and at least 1% prevalence in the population.
Results
Overall, 58,719 patients were identified that underwent surgery for prolapse including 36,889 under 65 years of age, 18,735 between ages 65 and 79, and 3,095 over 80.  Compared to the index population of patients under 65, patients in the elderly and very elderly groups had lower BMI, were less likely to smoke, less likely to be independent, had higher rates of diabetes, COPD, and cardiovascular disease, were more likely to undergo extraperitoneal apical suspension or obliterative surgery, and less likely to undergo intraperitoneal apical prolapse suspension (all p<0.001).  Rates of surgery for incontinence were similar.  The rate of serious complications in the index population was 5.1%.  Comparatively, elderly patients had a similar rate of serious complications at 4.8% (OR 0.9, 0.87-1.02, p=0.07), while the very elderly experienced a higher rate of serious complications at 10.7% (OR 2.2, 2.0-2.5, p<0.0001).  The very elderly had significantly elevated risk of cardiac complications (OR 14.1, 7.5-26.7), stroke (OR 23.9, 6.6-87.1), non-home discharge (OR 11.4, 9.1-14.4), and mortality within 30 days of surgery (OR 35.9, 10.5-122.4) (all p<0.0001).  On multivariate logistic regression, after controlling for confounders, age over 80 remained an independent predictor of serious complications (OR 2.1, 1.8-2.4, p<0.001).
Interpretation of results
The overall risk of serious complications after surgery is not significantly increased for patients between the ages of 65 to 80.  There is an increased risk of individual complications such as cardiac complications, stroke, and mortality, but this is balanced by decreased risk of certain complications such as sepsis and serious infection, blood transfusion, and reoperation.  Conversely, in patients over 80, the risk of serious complications is more than doubled, including a markedly increased risk of mortality, cardiac complications, stroke, and non-home discharge.
Concluding message
The risk of serious complications after surgery for pelvic organ prolapse is similar in elderly patients between the ages of 65-79 compared to younger patients.  Though, this rate sharply increases in patients over the age of 80, with a markedly increased risk of mortality, cardiovascular complications, and non-home discharge.  These data provide a framework with which to counsel elderly patients who desire to undergo elective surgery for pelvic organ prolapse.
Figure 1 Comparison of complications the index, elderly, and very elderly populations
Disclosures
<span class="text-strong">Funding</span> None <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> Metrohealth Institutional Review Board <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> No