Comparative Study of Postoperative Complications Associated With Modified Indiana Pouch in Elderly Versus Younger Patients

Abstract

Purpose We defined the nature and risk of complications associated with the modified Indiana pouch in patients older than 75 years. Materials and Methods We analyzed the clinical course of 25 elderly patients and a control group of 25 selected randomly from the cohort of those younger than 75 years. All patients underwent the modified Indiana pouch procedure. Charts were reviewed for type of operation, mean patient age, length of hospital stay, medical conditions, and early and late morbidity and mortality. Comparisons were made between the 2 groups. Results Simultaneous cystectomy or anterior exenteration was performed in 84 percent and 95 percent of patents in the elderly and younger groups, respectively. Mean age was 78.5 years in the elderly and 59.3 years in the younger group. Medical illnesses and early postoperative complication rates did not differ significantly between the 2 groups. Mean hospital stay was increased but not significantly in the elderly group (12.4 versus 11.1 days). There were 2 perioperative deaths in the elderly group (8 percent) and 1 in the control group (4 percent). Mean followup was 24.5 months (range 4 to 64) in the elderly versus 29.5 months (range 6 to 69) in the younger group. Late complications with the pouch were also similar (16 percent in the elderly and 12 percent in the control group). Of the elderly patients 9 died (intercurrent medical disease in 1 and cancer progression in 8) compared to 4 in the younger group (intercurrent medical disease in 1 and cancer progression in 3). Of the elderly patients 13 are alive (mean age 81 years) with a well functioning continent diversion. Conclusions The modified Indiana pouch can be created with acceptable postoperative morbidity and mortality in elderly patients, and it provides an excellent functional result.