Age as a risk factor for perioperative complications in women undergoing pelvic reconstructive surgery.

Objective: : The purpose of this study is to determine whether the age of a patient undergoing pelvic reconstructive and/or anti-incontinence pelvic surgery is a risk factor for perioperative complications.

Study Design: : A retrospective chart review was conducted of women who underwent pelvic reconstructive and anti-incontinence pelvic surgery between the years 2000 and 2006. The women underwent surgery by 1 urogynecologist, at 2 city hospitals. Patients with incomplete medical documentation were excluded from the study. The variables investigated included demographics, smoking history, prior surgical history, comorbidities, length of surgery, estimated blood loss, deep venous thrombosis prophylaxis, perioperative antibiotics, type of anesthesia, and the American Society of Anesthesia classification. The outcome variables included change in hematocrit, length of hospitalization, intraoperative injury, and prevalent postoperative complications. Postoperative complications included, febrile morbidity (T ≥ 101, ≥24 hours following surgery), documented infection (acute cystitis, wound or pelvic infection, and pneumonia), cardiovascular compromise (myocardial infarction, cerebral vascular accident, congestive heart failure, hypotension, arrhythmia), renal failure, graft erosion, dyspareunia, urinary retention, anemia (hematocrit ≤24%), ileus, hematoma, seroma, and ICU admission. A point system was created for each complication to limit the variation in data collection. Morbidity and mortality were determined for women aged ≤55 years old (group I), 56 to 69 years old (group II), and ≥70 years old (group III). One-way analysis of variance was used to determine whether a difference exist between the age groups, and exact χ tests were used to identify the association between age and the aforementioned outcome variables. An alpha level of 0.05 was predetermined as the level of statistical significance.

Results: : A total of 411 patients underwent pelvic reconstructive surgery, 404 surgical procedures met the inclusion criteria, group I (n = 168), group II (n = 152), and group III (n = 84). Most surgeries were done vaginally. The women were followed up for an average of 185 days (group I), 243 days (group II), and 248 days (group III). There was no significant difference in the operative time, length of hospitalization, or follow-up period between the groups. Demographically, the groups had a similar composition. There are minor differences in prior medical and surgical histories between the age groups. Older women were more likely to have a history of cardiovascular disease. Patients in group II were more likely to have a prior history of a midurethral sling (P = 0.02). Patients in group III, were more likely to have a prior history of an abdominal hysterectomy (P = 0.01) and anterior colporrhaphy with graft (P = 0.01). In this study, group II underwent more salpingectomies (P = 0.01) and group III underwent more hysterectomies (P = 0.01), oophorectomies (P = 0.05), and posterior colporrhaphies (P = 0.001). Overall, the rate of intraoperative complications was 1.0%. There was no statistical difference in the postoperative complication rate among the 3 age groups (P = 0.27) and no fatalities.

Conclusion: : The age of a patient undergoing vaginal reconstructive and/or anti-incontinence pelvic surgery does not appear to be a risk factor for perioperative complications.