57 Complications following prolapse surgery in older women

Abstract

To describe perioperative outcomes following prolapse surgery in women age 75 years and older and to assess factors associated with complications following prolapse (POP) surgery in this cohort compared to women younger than 75. Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we identified women undergoing POP surgery between 2012 and 2018 using ICD postoperative diagnosis codes. Patient demographics, American Society of Anesthesiologists (ASA) classification score, major medical comorbidities (MMC), readmission, reoperation, and 30-day postoperative complications (POC) were abstracted. Univariate and bivariate analyses were performed, and multivariable logistic regression (MVLR) was performed to examine the role of age ≥75 (75+) in postoperative complications, controlling for other potential confounders. A subanalysis of the 75+ cohort was performed to identify factors associated with complications in this cohort. During the study period, 28,411 women underwent prolapse repair surgery, 14.4% of whom were 75+. Significant differences were noted in all patient and surgical characteristics between those <75 and those 75+ (P<.05) with the exception of length of stay and reoperation (Table 1). The overall rate of POC for all women undergoing POP repair was 6.6% with the most common complication being urinary tract infections (UTI) (4.1%), followed by transfusions (0.7%) and superficial incisional surgical site infections (0.5%). The overall readmission rate was 2.3%. Unadjusted rates of postoperative complications and readmissions were higher in the 75+ cohort (7.5% vs 6.5%, P=0.02 and 3.0% vs 2.2%, P=.001, respectively). In a MVLR controlling for BMI, ASA Class, race, MMC, smoking and surgical procedures, age 75+ was not associated with an increased odds of either a POC or non-UTI POC. Controlling for the same factors, 75+ was, however, associated with increased odds of readmission (Table 2). Approximately 15% of women undergoing surgery for prolapse are 75 years of age or older. While postoperative complications are not associated with age 75+, readmission following POP surgery remains higher among older women even when controlling for patient and surgical factors. Surgeons should keep these findings in mind when counseling patients regarding risks following POP surgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)