Abstract
Introduction and hypothesis
Previous research has demonstrated similar complication rates in older and younger women undergoing abdominal sacral colpopexy via laparotomy. The objective of this study was to compare perioperative complications in older and younger women undergoing minimally invasive sacral colpopexy.
Methods
This was a retrospective study of laparoscopic and robotic sacral colpopexies performed from January 2009 to May 2012 at a large academic center. Patient demographics, surgical data, and perioperative complications were compared in women < 65 and ≥65 years of age. Primary outcome was the difference in major complications.
Results
A total of 302 women underwent minimally invasive sacral colpopexy during the study period. Mean age was 58.5 ± 8.8 years and 84 subjects (27.8 %) were ≥65 years. Older women were more likely to have had a prior hysterectomy (60.7 vs 39.0 %, p = 0.001) and had more severe preoperative prolapse (86.9 % vs 71.9 % ≥ POPQ stage III, p = 0.01). There was no significant difference in duration of hospitalization (1.4 vs 1.4 days, p = 0.54). Overall, there were significantly more major complications in women ≥ 65 years (unadjusted OR 1.84, 95 % CI 1.02–3.35, p = 0.04). After controlling for BMI, route of surgery, estimated blood loss (EBL), and operating room time, age ≥ 65 remained a significant predictor of complications (adjusted OR 2.28, 95 % CI 1.21–4.29, p = 0.01).
Conclusions
Our findings suggest that older women have a higher rate of major complications following minimally invasive sacral colpopexy, even after controlling for BMI, route of surgery, EBL, and operating room time. This increased risk should be addressed during preoperative counseling and may influence surgical planning.
Similar content being viewed by others
References
Jones KA, Shepherd JP, Oliphant SS, Wang L, Bunker CH, Lowder JL (2010) Trends in inpatient prolapse procedures in the United States, 1979–2006. Am J Obstet Gynecol 200(501):e1–7
Smith FJ, Holman CD, Moorin RE, Tsokos N (2010) Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 116(5):1096–1100
Luber KM, Boero S, Choe JY (2001) The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 184(7):1496–1501
United Nations. Population ageing and development 2012. http://www.un.org/en/development/desa/population/publications/pdf/ageing/2012PopAgeingandDev_WallChart.pdf. Accessed 10 July 2013
Vetere PF, Putterman S, Kesselman E (2003) Major reconstructive surgery for pelvic organ prolapse in elderly women including the medically compromised. J Reprod Med 48(6):417–421
Tuschy B, Berlit S, Hornemann A, Sutterlin M, Bussen S (2012) Morbidity in elderly women undergoing gynaecological pelvic floor surgery. Arch Gynecol Obstet 285:1295–1300
Richter HE, Goode PS, Kenton K, Brown MB, Burgio KL, Kreder K, Moalli P, Wright EJ, Weber AM (2007) The effect of age on short-term outcomes after abdominal surgery for pelvic organ prolapse. J Am Geriatr Soc 55:857–863
Sung V, Weitzen S, Sokol ER, Rardin CR, Myers DL (2006) Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol 194:1411–1417
Lane FE (1962) Repair of posthysterectomy vaginal-vault prolapse. Obstet Gynecol 20:72–77
Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse. Cochrane Database Syst Rev 4, CD004014
Liss MA, Skarecky D, Morales B, Osann K, Eichel L, Ahlering TE (2013) Preventing perioperative complications of robotic-assisted radical prostatectomy. Urology 81(2):319–323
Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD (2005) Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol 192:1630–1636
Geller EJ, Siddiqui NY, Wu JM, Visco AG (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112(6):1201–1206
Centinel B, Oktay D, Bulent O, Akkus E, Alan C, Can G (2004) Are there any factors predicting the cure and complication rates of tension-free vaginal tape? Int Urogynecol J Pelvic Floor Dysfunct 15:188
Friedman WH, Gallup DG, Burke JJ, Meister EA, Hoskins WJ (2006) Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery. Am J Obstet Gynecol 195:547
Barber MD, Amudsen CL, Paraiso MFR, Weidner AC, Romero A, Walters MD (2007) Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery. Int Urogynecol J Pelvic Floor Dysfunct 18:799
American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60(4):616–631.
Lambrou NC, Buller JL, Thompson JR, Cundiff GW, Chou B, Montz FJ (2000) Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery. Am J Obstet Gynecol 183(6):1355–1358
Gerten KA, Markland AD, Lloyd LK, Richter HE (2008) Prolapse and incontinence surgery in older women. J Urol 179(6):2111–2118
Robinson BL, Parnell BA, Sandbulte JT, Geller EJ, Connolly A, Matthews CA (2013) Robotic versus vaginal urogynecologic surgery: a retrospective cohort study of perioperative complications in elderly women. Female Pelvic Med Reconstr Surg 19(4):230–237
Kantartzis K, Sutkin G, Winger D, Wang L, Shepherd JP (2013) Introduction of laparoscopic sacral colpopexy to a fellowship training program. Int Urogynecol J 24:1877–1881
Kaminski P, Soroskiy J, Pees R, Podczaski ES (1993) Correction of massive vaginal prolapse in an older population: A four year experience at a rural tertiary care center. J Am Geriatr Soc 41:42–44
Authors’ contributions
L.C. Turner: project development, data analysis, manuscript writing, and editing; K. Kantartzis: project development, data management, manuscript editing; J.L. Lowder: project development, manuscript editing; J.P. Shepherd: project development, data analysis, manuscript editing.
Financial support
None.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Turner, L.C., Kantartzis, K., Lowder, J.L. et al. The effect of age on complications in women undergoing minimally invasive sacral colpopexy. Int Urogynecol J 25, 1251–1256 (2014). https://doi.org/10.1007/s00192-014-2391-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-014-2391-0