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Association of Age With Adverse Events After Pelvic Organ Prolapse Surgery
Rodger W Rothenberger1, Jeremy T Gaskins2, Laurel Carbone1
1Department of OBGYN and Women's Health, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Louisville.
Insights
Pelvic organ prolapse (POP) surgery outcomes are favorable across age groups, including those over 80. Older patients (60-79) experienced fewer major complications compared to younger individuals, demonstrating the safety of POP procedures in diverse age demographics.
Area of Science:
- Urogynecology
- Surgical Outcomes Research
- Geriatric Surgery
Background:
- Pelvic organ prolapse (POP) affects many women, with surgical intervention being a common treatment.
- Patient age is a critical factor in surgical decision-making for POP, yet its impact on perioperative outcomes requires further elucidation.
Purpose of the Study:
- To investigate the association between patient age and 30-day perioperative outcomes following surgical repair of pelvic organ prolapse.
- To determine if age influences the risk of major or minor complications after POP surgery.
Main Methods:
- Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program database (2011-2022).
- Analysis included 133,058 women undergoing POP surgery, categorized into age groups (18-59, 60-69, 70-79, 80+).
- Multivariate logistic regression and interaction models assessed age-related complication risks and the impact of concomitant procedures.
Main Results:
- Women aged 60-79 years demonstrated significantly lower rates of major complications compared to those younger than 60.
- Patients aged 80 and older showed similar rates of major complications to the youngest cohort.
- The addition of a hysterectomy slightly increased major complication risk only in patients younger than 60.
Conclusions:
- Surgical treatment for pelvic organ prolapse is associated with a low risk of perioperative complications across all age groups, including the elderly.
- These findings support the safety and efficacy of POP surgery in older adult populations, informing surgical decision-making.
Importance:
When treating pelvic organ prolapse (POP) through surgery, age may factor into joint decision making for surgeons and patients.
Objective:
The objective of this study was to determine if 30-day perioperative outcomes after POP surgery vary by age.
Study Design:
This was a retrospective cohort study of women who underwent surgery for POP using the 2011-2022 American College of Surgeons National Surgical Quality Improvement Program database. Composite rates of adverse events were categorized as major complications (deep/organ space surgical site infection [SSI], reintubation, renal failure, wound dehiscence, pulmonary embolism, cardiac arrest, myocardial infarction, deep vein thrombosis, sepsis, septic shock, return to operating room, stroke, and death) or minor complications (pneumonia, blood transfusion, superficial SSI, or urinary tract infection). Multivariate logistic regression models were used to assess the association between patient age and perioperative complications after adjusting for relevant variables. Interaction models were created to determine if age modulates the effect of procedure type (apical, nonapical, obliterative prolapse surgery) or concomitant hysterectomy on risk of complications.
Results:
We included 133,058 women (aged 18-59 years, n=60,659, 45.6%; aged 60-69 years, n=37,818, 28.4%; aged 70-79 years, n=27,598, 20.7%; aged 80 years and older, n=6,983, 5.2%) who underwent POP surgical procedures. On multivariate logistic regression, relative to patients younger than 60 years, age groups 60-69 years and 70-79 years had significantly lower rates of major complications (60-69 years: adjusted odds ratio [aOR]=0.68 [0.62-0.74]; 70-79 years: aOR=0.71 [0.64-0.78]) and patients older than 80 years had similar rates of major complications (aOR=0.98 [0.86-1.12]). In the patients younger than 60 years, the addition of a hysterectomy to a prolapse procedure carried a slightly increased risk of major complications (aOR=1.19, 95% CI=1.06-1.32). No other group carried an increased risk of major complications when adding a hysterectomy or performing an apical or obliterative repair.
Conclusion:
This study shows a low risk of complications after POP procedures, even in patients older than 80 years.
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