nach oben

International Urogynecology Journal

Erschienen in:

03.01.2020 | Original Article

Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy

Erschienen in: International Urogynecology Journal | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

Pelvic floor disorders are common among and disproportionately affect older women. There are limited data regarding perioperative adverse events in older women undergoing robot-assisted sacrocolpopexy (RASC) specifically. The aim of this study was to compare the rate of perioperative adverse events in younger (age <65 years) versus older (age >65 years) women who underwent RASC.

Methods

We conducted a retrospective cohort study of women who underwent RASC between 2013 and 2018. Postoperative adverse events were categorized according to the Clavien–Dindo classification. Our primary outcome was the rate of intraoperative adverse events and postoperative adverse events with Clavien–Dindo grade II or greater. Outcomes were compared using univariate and multivariate analysis.

Results

Of the 327 patients included in the study, 227 were <65 years of age and 100 were ≥65 years of age. Women ≥65 years of age had higher rates of hypertension, higher American Society of Anesthesiologist (ASA) class, and higher Charlson Comorbidity Index (CCI) scores compared with women <65 years of age; these were not associated with increased likelihood of adverse events. The overall rate of any perioperative adverse event was 18.3%. There was no statistically significant difference in the overall rate of perioperative adverse events between younger and older women (18.5% vs 18.0%, p = 0.91).

Conclusions

There is no difference in rate of adverse events between women ≥65 years of age undergoing RASC and their younger counterparts.

Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–503. https://doi.org/10.1067/mob.2001.114868.CrossRefPubMed

Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women. Obstet Gynecol. 2009;114(6):1278–83. https://doi.org/10.1097/AOG.0b013e3181c2ce96.CrossRefPubMed

Nygaard I, Barber MD, Burgio KL, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. JAMA 2008;300(11):1311-6CrossRefPubMedPubMedCentral

Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8. https://doi.org/10.1097/AOG.0000000000000057.CrossRefPubMedPubMedCentral

Patel DN, Anger JT. Surgery for pelvic organ prolapse. Curr Opin Urol. 2016;26(4):302-8. https://doi.org/10.1097/MOU.0000000000000288.CrossRefPubMed

Erekson E, Murchison RL, Gerjevic KA, Meljen VT, Strohbehn K. Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am J Obstet Gynecol. 2017;217(5):608.e1–17. https://doi.org/10.1016/j.ajog.2017.05.052.CrossRef

Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23. https://doi.org/10.1097/01.AOG.0000139514.90897.07.CrossRefPubMed

Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: A prospective randomized study. Am J Obstet Gynecol. 2004;190(1):20–6. https://doi.org/10.1016/j.ajog.2003.08.031.CrossRefPubMed

Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 1996;175(6):1418–21; discussion 1421–2.CrossRefPubMed

10.

Turner LC, Kantartzis K, Lowder JL, Shepherd JP. The effect of age on complications in women undergoing minimally invasive sacral colpopexy. Int Urogynecol J. 2014;25(9):1251–6. https://doi.org/10.1007/s00192-014-2391-0.CrossRefPubMed

11.

Hudson CO, Northington GM, Lyles RH, Karp DR. Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg. 2014;20(5):252–60. https://doi.org/10.1097/SPV.0000000000000070.CrossRefPubMedPubMedCentral

12.

Danforth TL, Monish A, Ginsberg DA. Robotic sacrocolpopexy. Indian J Urol. 2014;30(3):318. https://doi.org/10.4103/0970-1591.128502.CrossRefPubMedPubMedCentral

13.

Gilleran JP, Matthew J, Andrew H. Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010;2(5–6):195–208. https://doi.org/10.1177/1756287210379120.CrossRefPubMedPubMedCentral

14.

Geertje C, Bosteels J, Housmans S, et al. Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. Gynecol Surg. 2016;13:115–23. https://doi.org/10.1007/s10397-016-0930-z.CrossRef

15.

Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract 2001;4(4):172–7.PubMed

16.

Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006;194(5):1411–7. https://doi.org/10.1016/j.ajog.2006.01.050.CrossRefPubMed

17.

Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol. 2005;192(5):1630–6. https://doi.org/10.1016/j.ajog.2004.11.026.CrossRefPubMed

18.

Unger CA, Hickman LC, Mitchell-Handley B, Barber MD, Ridgeway B. The incidence of perioperative adverse events in the very elderly undergoing urogynecologic surgery. Female Pelvic Med Reconstr Surg. 2016;22(6):425–9. https://doi.org/10.1097/SPV.0000000000000309.CrossRefPubMed

19.

Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9. https://doi.org/10.1111/j.1532-5415.2005.53159.x.CrossRefPubMed

20.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

21.

Tuschy B, Berlit S, Hornemann A, Sütterlin M, Bussen S. Morbidity in elderly women undergoing gynaecological pelvic floor surgery. Arch Gynecol Obstet. 2012;285(5):1295–300. https://doi.org/10.1007/s00404-011-2130-4.CrossRefPubMed

22.

Vetere PF, Putterman S, Kesselman E. Major reconstructive surgery for pelvic organ prolapse in elderly women, including the medically compromised. J Reprod Med. 2003;48(6):417–21.PubMed

23.

Bretschneider CE, Robinson B, Geller EJ, Wu JM. The effect of age on postoperative morbidity in women undergoing urogynecologic surgery. Female Pelvic Med Reconstr Surg. 2015;21(4):236–40. https://doi.org/10.1097/SPV.0000000000000150.CrossRefPubMed

24.

Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R. Laparoscopic appendectomy in the elderly. Surgery. 2004;135(5):479–88. https://doi.org/10.1016/J.SURG.2003.12.007.CrossRefPubMed

25.

Hewitt J, McCormack C, Tay HS, et al. Prevalence of multimorbidity and its association with outcomes in older emergency general surgical patients: an observational study. BMJ Open. 2016;6(3):e010126. https://doi.org/10.1136/bmjopen-2015-010126.CrossRefPubMedPubMedCentral

26.

Robinson BL, Parnell BA, Sandbulte JT, Geller EJ, Connolly A, Matthews CA. Robotic versus vaginal urogynecologic surgery: a retrospective cohort study of perioperative complications in elderly women. Female Pelvic Med Reconstr Surg. 2013;94(4):547–8. https://doi.org/10.1097/SPV.CrossRef

27.

Friedman WH, Gallup DG, Burke JJ, Meister EA, Hoskins WJ. Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery. Am J Obstet Gynecol. 2006;195(2):547–52; discussion 552–3. https://doi.org/10.1016/j.ajog.2006.03.085.CrossRefPubMed

28.

De Gouveia De Sa M, Claydon LS, Whitlow B, Dolcet Artahona MA. Robotic versus laparoscopic sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(3):355–66. https://doi.org/10.1007/s00192-015-2763-0.CrossRefPubMed

29.

Guy MS, Sheeder J, Behbakht K, Wright JD, Guntupalli SR. Comparative outcomes in older and younger women undergoing laparotomy or robotic surgical staging for endometrial cancer. J Am Coll Surg. 2014;214(3):350.e1–10. https://doi.org/10.1016/j.jamcollsurg.2014.07.161.CrossRef

30.

Greer JA, Harvie HS, Andy UU, Smith AL, Northington GM, Arya LA. Short-term postoperative functional outcomes in older women undergoing prolapse surgery. Obstet Gynecol. 2015;;125(3):551–8. https://doi.org/10.1097/AOG.0000000000000644.CrossRefPubMedPubMedCentral

31.

Greer JA, Northington GM, Harvie HS, Segal S, Johnson JC, Arya LA. Functional status and postoperative morbidity in older women with prolapse. J Urol. 2013;190(3):948–52. https://doi.org/10.1016/j.juro.2013.03.004.CrossRefPubMed

32.

Grønkjær M, Eliasen M, Skov-Ettrup LS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52–71. https://doi.org/10.1097/SLA.0b013e3182911913.CrossRefPubMed

Titel: Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy
Publikationsdatum: 03.01.2020
Erschienen in: International Urogynecology Journal / Ausgabe 7/2020
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04180-9

Neu im Fachgebiet Gynäkologie und Geburtshilfe

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Hochrisiko-Eingriffe für postoperative Übelkeit

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Gynäkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2020

Workup and conservative management of ileal conduit-vaginal fistulas: review of literature

Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience

Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial

Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?

A commentary on “Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial”

Cost-effectiveness of a preoperative pelvic MRI in pelvic organ prolapse surgery

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Hochrisiko-Eingriffe für postoperative Übelkeit

Adjuvante Brustkrebstherapie: Doppelt hält besser

Manche Gestagene können das Risiko für Meningeome erhöhen

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Gynäkologie