Skip to main content

Advertisement

SpringerLink
Log in

Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Pelvic floor disorders are common among and disproportionately affect older women. There are limited data regarding perioperative adverse events in older women undergoing robot-assisted sacrocolpopexy (RASC) specifically. The aim of this study was to compare the rate of perioperative adverse events in younger (age <65 years) versus older (age >65 years) women who underwent RASC.

Methods

We conducted a retrospective cohort study of women who underwent RASC between 2013 and 2018. Postoperative adverse events were categorized according to the Clavien–Dindo classification. Our primary outcome was the rate of intraoperative adverse events and postoperative adverse events with Clavien–Dindo grade II or greater. Outcomes were compared using univariate and multivariate analysis.

Results

Of the 327 patients included in the study, 227 were <65 years of age and 100 were ≥65 years of age. Women ≥65 years of age had higher rates of hypertension, higher American Society of Anesthesiologist (ASA) class, and higher Charlson Comorbidity Index (CCI) scores compared with women <65 years of age; these were not associated with increased likelihood of adverse events. The overall rate of any perioperative adverse event was 18.3%. There was no statistically significant difference in the overall rate of perioperative adverse events between younger and older women (18.5% vs 18.0%, p = 0.91).

Conclusions

There is no difference in rate of adverse events between women ≥65 years of age undergoing RASC and their younger counterparts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–503. https://doi.org/10.1067/mob.2001.114868.

    Article  CAS  PubMed  Google Scholar 

  2. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women. Obstet Gynecol. 2009;114(6):1278–83. https://doi.org/10.1097/AOG.0b013e3181c2ce96.

    Article  PubMed  Google Scholar 

  3. Nygaard I, Barber MD, Burgio KL, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. JAMA 2008;300(11):1311-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8. https://doi.org/10.1097/AOG.0000000000000057.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Patel DN, Anger JT. Surgery for pelvic organ prolapse. Curr Opin Urol. 2016;26(4):302-8. https://doi.org/10.1097/MOU.0000000000000288.

    Article  PubMed  Google Scholar 

  6. Erekson E, Murchison RL, Gerjevic KA, Meljen VT, Strohbehn K. Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am J Obstet Gynecol. 2017;217(5):608.e1–17. https://doi.org/10.1016/j.ajog.2017.05.052.

    Article  Google Scholar 

  7. Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23. https://doi.org/10.1097/01.AOG.0000139514.90897.07.

    Article  PubMed  Google Scholar 

  8. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: A prospective randomized study. Am J Obstet Gynecol. 2004;190(1):20–6. https://doi.org/10.1016/j.ajog.2003.08.031.

    Article  PubMed  Google Scholar 

  9. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 1996;175(6):1418–21; discussion 1421–2.

    Article  CAS  PubMed  Google Scholar 

  10. Turner LC, Kantartzis K, Lowder JL, Shepherd JP. The effect of age on complications in women undergoing minimally invasive sacral colpopexy. Int Urogynecol J. 2014;25(9):1251–6. https://doi.org/10.1007/s00192-014-2391-0.

    Article  CAS  PubMed  Google Scholar 

  11. Hudson CO, Northington GM, Lyles RH, Karp DR. Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg. 2014;20(5):252–60. https://doi.org/10.1097/SPV.0000000000000070.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Danforth TL, Monish A, Ginsberg DA. Robotic sacrocolpopexy. Indian J Urol. 2014;30(3):318. https://doi.org/10.4103/0970-1591.128502.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gilleran JP, Matthew J, Andrew H. Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010;2(5–6):195–208. https://doi.org/10.1177/1756287210379120.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Geertje C, Bosteels J, Housmans S, et al. Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. Gynecol Surg. 2016;13:115–23. https://doi.org/10.1007/s10397-016-0930-z.

    Article  Google Scholar 

  15. Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract 2001;4(4):172–7.

    CAS  PubMed  Google Scholar 

  16. Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006;194(5):1411–7. https://doi.org/10.1016/j.ajog.2006.01.050.

    Article  PubMed  Google Scholar 

  17. Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol. 2005;192(5):1630–6. https://doi.org/10.1016/j.ajog.2004.11.026.

    Article  PubMed  Google Scholar 

  18. Unger CA, Hickman LC, Mitchell-Handley B, Barber MD, Ridgeway B. The incidence of perioperative adverse events in the very elderly undergoing urogynecologic surgery. Female Pelvic Med Reconstr Surg. 2016;22(6):425–9. https://doi.org/10.1097/SPV.0000000000000309.

    Article  PubMed  Google Scholar 

  19. Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9. https://doi.org/10.1111/j.1532-5415.2005.53159.x.

    Article  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tuschy B, Berlit S, Hornemann A, Sütterlin M, Bussen S. Morbidity in elderly women undergoing gynaecological pelvic floor surgery. Arch Gynecol Obstet. 2012;285(5):1295–300. https://doi.org/10.1007/s00404-011-2130-4.

    Article  PubMed  Google Scholar 

  22. Vetere PF, Putterman S, Kesselman E. Major reconstructive surgery for pelvic organ prolapse in elderly women, including the medically compromised. J Reprod Med. 2003;48(6):417–21.

    PubMed  Google Scholar 

  23. Bretschneider CE, Robinson B, Geller EJ, Wu JM. The effect of age on postoperative morbidity in women undergoing urogynecologic surgery. Female Pelvic Med Reconstr Surg. 2015;21(4):236–40. https://doi.org/10.1097/SPV.0000000000000150.

    Article  PubMed  Google Scholar 

  24. Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R. Laparoscopic appendectomy in the elderly. Surgery. 2004;135(5):479–88. https://doi.org/10.1016/J.SURG.2003.12.007.

    Article  PubMed  Google Scholar 

  25. Hewitt J, McCormack C, Tay HS, et al. Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study. BMJ Open. 2016;6(3):e010126. https://doi.org/10.1136/bmjopen-2015-010126.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Robinson BL, Parnell BA, Sandbulte JT, Geller EJ, Connolly A, Matthews CA. Robotic versus vaginal urogynecologic surgery: a retrospective cohort study of perioperative complications in elderly women. Female Pelvic Med Reconstr Surg. 2013;94(4):547–8. https://doi.org/10.1097/SPV.

    Article  Google Scholar 

  27. Friedman WH, Gallup DG, Burke JJ, Meister EA, Hoskins WJ. Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery. Am J Obstet Gynecol. 2006;195(2):547–52; discussion 552–3. https://doi.org/10.1016/j.ajog.2006.03.085.

    Article  PubMed  Google Scholar 

  28. De Gouveia De Sa M, Claydon LS, Whitlow B, Dolcet Artahona MA. Robotic versus laparoscopic sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(3):355–66. https://doi.org/10.1007/s00192-015-2763-0.

    Article  PubMed  Google Scholar 

  29. Guy MS, Sheeder J, Behbakht K, Wright JD, Guntupalli SR. Comparative outcomes in older and younger women undergoing laparotomy or robotic surgical staging for endometrial cancer. J Am Coll Surg. 2014;214(3):350.e1–10. https://doi.org/10.1016/j.jamcollsurg.2014.07.161.

    Article  Google Scholar 

  30. Greer JA, Harvie HS, Andy UU, Smith AL, Northington GM, Arya LA. Short-term postoperative functional outcomes in older women undergoing prolapse surgery. Obstet Gynecol. 2015;;125(3):551–8. https://doi.org/10.1097/AOG.0000000000000644.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Greer JA, Northington GM, Harvie HS, Segal S, Johnson JC, Arya LA. Functional status and postoperative morbidity in older women with prolapse. J Urol. 2013;190(3):948–52. https://doi.org/10.1016/j.juro.2013.03.004.

    Article  PubMed  Google Scholar 

  32. Grønkjær M, Eliasen M, Skov-Ettrup LS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52–71. https://doi.org/10.1097/SLA.0b013e3182911913.

    Article  PubMed  Google Scholar 

Download references

Funding

Financial support: Dr Uduak Andy is supported by a grant from the National Institute of Aging (R03-AG-053277-01, PI: Andy). For the remaining authors, no conflicts of interests are declared.

Author information

Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 5 Dulles, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Christopher X. Hong, Priyanka K. Halani, Heidi S. Harvie, Lily A. Arya & Uduak U. Andy

  2. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, 19104, PA, USA

    Naomi Gutkind

Authors
  1. Christopher X. Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Priyanka K. Halani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naomi Gutkind
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heidi S. Harvie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lily A. Arya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Uduak U. Andy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher X. Hong.

Ethics declarations

Conflicts of interest

The authors report no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hong, C.X., Halani, P.K., Gutkind, N. et al. Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy. Int Urogynecol J 31, 1463–1470 (2020). https://doi.org/10.1007/s00192-019-04180-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04180-9

Keywords

Search

Navigation