Morbidity and Outcomes of Urogynecological Surgery in Elderly Women

Abstract

To the Editor: Given that the lifetime risk for undergoing pelvic organ prolapse surgery is approximately 11% and that prolapse is the most common reason for hysterectomy in patients aged 55 and older, the need to address this issue in older women is a growing challenge for gynecological surgeons. 1 Although surgical therapy in elderly women with malignancy or an intra-abdominal surgical emergency has been shown to be safe and effective, many patients and physicians are naturally hesitant to choose major pelvic surgery for a non-life-threatening disease. 2-5 Previous research has shown low perioperative morbidity 6-9 in elderly patients undergoing urogynecological surgery, but preexisting comorbidities, such as cardiovascular disease, can increase the risk of a significant perioperative complication.A retrospective chart review of 144 consecutive patients who underwent urogynecological surgery by one surgeon between 1998 and 2007 was performed to investigate the safety and effectiveness of reconstructive pelvic surgery in older women by comparing their outcomes with those of a group undergoing similar procedures at a significantly younger age.There were 49 patients younger than 65 (average age 51.6) and 95 aged 65 and older, including 20 aged 80 and older (average age 75). Surgical procedures and complications are listed in Table 1. Five of the 49 (10.2%) patients in the younger (o65) group had a total of five preoperative comorbidities, and 43 of the 95 (45.3%) patients in the older (! 65) group had a total of 64 preoperative comorbidities (Po.005). The comorbidities included coronary artery disease, valvular disease, arrhythmia, peripheral vascular disease, hypertension, chronic pulmonary disease, history of venous thromboembolic disease, diabetes mellitus, chronic anticoagulation, collagen-vascular disease, prior cerebrovascular disease, Parkinson's disease, renal disease, thyroid disease, and history of malignancy. The majority of patients had several procedures performed at the time of surgery. Complication rates, including medical, surgical, and transfusion complications, were similar: 13.7% (13/95, 95% CI 5 7.5-22.3) in the older group and 14.3% (7/49, 95% CI 5 5.9-27.2) in the younger group (P 5.99). Forty-eight patients had anti-incontinence surgery for symptoms of stress urinary incontinence. Twentyseven patients underwent Marshall-Marchetti-Kranz urethropexies, with two failures, indicating a subjective success rate of 92.6%. Twenty-one patients had midurethral slings, with two failures, indicating a success rate of 90.5%.The majority of the patients had surgery performed for pelvic organ prolapse. Five of 87 patients in the older group treated for pelvic organ prolapse experienced a symptomatic recurrence, resulting in a 94.3% patient satisfaction (subjective improvement) rate (95% CI 5 87.1-98.1). In the younger group, one of 37 cases treated for pelvic organ prolapse experienced a symptomatic recurrence, for a 97.3% satisfaction rate, (95% CI 5 85.8-99.9 P 5.67). ''Surgical cure'' rates were 94.6% i...