You’re How Old? Correlating Perioperative Complication Risk in Octogenarians Undergoing Colpocleisis for Pelvic Organ Prolapse

Abstract

Objectives Colpocleisis is a surgical treatment of pelvic organ prolapse for elderly women who are no longer sexually active. The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicts perioperative complications. We aim to determine if the NSQIP calculated risk correlates with true perioperative complications in women 80 years or older undergoing colpocleisis. Methods Octogenarian women who underwent colpocleisis at our institution from 2007 to 2017 were included in this retrospective chart review. Medical comorbidities were entered into ACS NSQIP calculator, and the calculated risk was compared with actual complications. Results One hundred twenty-six octogenarians were included in the analysis. The true complication rate was higher than predicted by NSQIP (28.6% [36/126] vs 4.3% (SD, ±1.1%), which we attribute to our relatively high detection rate of urinary tract infection (32/36). Four patients (3.2%) had serious complications (pulmonary embolus, deep vein thrombosis, sepsis, and reintubation). In only 57% of cases, NSQIP risk calculation was concordant with true complication, showing significant departure from correct classification (P < 0.0001). The sensitivity and specificity of the NSQIP calculator were 66.7% and 53.3%, respectively. Multivariable analysis showed higher-than-predicted incidence of complications for patients requiring antiplatelet medication (Plavix or aspirin >81 mg vs none; odds ratio, 4.84, 95% confidence interval, 1.72–13.60; P = 0.002) and a diagnosis of hypertension (odds ratio, 4.24; 95% confidence interval, 1.31–13.72; P = 0.016). Conclusion Serious complication rates are low in octogenarians undergoing colpocleisis. The ACS NSQIP risk calculator does not strongly correlate with actual complications. Further refinement and evolvement of the database may improve its predictive value.

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

“…Mean patient age ranged from 69.0 ± 8.0 [ 39 ] to 84 ± 3.1 years [ 40 ]. The oldest patients undergoing surgery were 95.9 [ 25 ] and 101 years [ 34 ].…”

“…Subjects with POP-Q stage 2 constituted an insignificant percentage of the group, from 1.1% to 9.8% [ 6 , 12 , 23 , 25 , 26 , 36 , 37 , 39 ]. A few studies either used other POP scales or did not clearly state which tools were used [ 32 , 40 , 42 ].…”

“…Initiation of antibiotics for suspected UTI with no culture resulted in the rate of 26.1% [ 22 ]. Sifuentes et al, who based their estimates on both these definitions, detected a UTI rate of 25.4% [ 40 ]. Fitzgerald et al reported urogenital symptoms during 3 months of follow-up in as many as 45% of the patients, stating that these were mostly UTIs [ 29 ].…”

“…In a retrospective analysis of calculator-computed risk, the patients with preoperative use of antiplatelets (clopidogrel or acetylsalicylic acid >81 mg) were nearly 5-fold more likely to experience complications than patients with no antithrombotic medication (adjusted OR 4.84; 95% CI, 1.72–13.60; p = 0.002). What is more, patients with hypertension were 4.25-fold more likely to experience a complication than those without hypertension (adjusted OR 4.24; 95% CI, 1.31–13.720; p = 0.016) [ 40 ].…”

Vaginal mesh surgery is efficient to treat pelvic organ prolapse grade 3 in elderly women

“…В настоящее время появление новых синтетических материалов и методик хирургической коррекции НМТД 3 степени произвели революцию в лечении этого заболевания [6]. Методы хирургической коррекции позволяют хорошо купировать симптомы пролапса, мочевой и каловой инконтиненции, однако их эффективность у пациенток пожилого возраста, у которых за счет длительного дефицита половых гормонов имеются выраженные инволютивные изменения в репродуктивной системе, остается открытым [7]. Тем не менее, вторичные исходы исследования показали эффективность хирургической коррекции НМТД 3 степени у женщин пожилого возраста, улучшая качество жизни и снижая частоту и интенсивность симптомов заболевания.…”