Prolapse repair in the elderly patient: contemporary trends and 30-day perioperative complications

Pelvic organ prolapse is common and increases with age. Although conservative options exist for management, surgery remains a mainstay of treatment. Understanding how surgical repair affects the elderly is increasingly important as the population ages. We set out to describe current treatment patterns for prolapse repair in the elderly. Our main goal was to compare perioperative morbidity and mortality for elderly patients who undergo surgical repair of pelvic organ prolapse with colpocleisis, vaginal repair or sacrocolpopexy.

Women 75 years and older who underwent prolapse repair from 2014 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology (CPT) codes for colpocleisis, vaginal prolapse repair, and abdominal sacrocolpopexy. Variables including demographics, comorbidities, concomitant hysterectomy or stress urinary incontinence procedure, hospital length of stay, morbidity, and mortality were evaluated. A regression model was used to analyze risk factors for perioperative complications.

We identified 764 women who underwent prolapse repair. The largest proportion of patients (334, 43.7%) underwent transvaginal repair, closely followed by colpocleisis (323, 42.3%), and the remainder (107, 14%) sacrocolpopexy. Older age and higher ASA class were significantly associated with colpocleisis (p < 0.001, p = 0.03). No difference was observed in complications across the three approaches, but length of stay was shorter (1.2 days vs 1.7 days, p = 0.03) for colpocleisis.

In current practice, patients undergoing colpocleisis compared with transvaginal repair or sacrocolpopexy are older with more comorbidities. Despite this, length of stay remains shorter for these patients and complications rates equivalent.