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Counsel the Elderly About Increased Risks of Urogynecologic Procedures


 

ATLANTA — Advanced age is an independent risk factor for in-hospital mortality and perioperative complications in women undergoing urogynecologic surgery, Vivian W. Sung, M.D., reported at the annual meeting of the American Urogynecologic Society.

In a retrospective cohort study of 264,340 women who underwent inpatient urogynecologic procedures from 1998 to 2002, the in-hospital mortality rate was 2.8% in those aged 80 and older, compared with 0.9% in those 70–79 years old, 0.5% in those aged 60–69, and 0.1% in those younger than 60, said Dr. Sung of Brown University, Providence, R.I.

The findings have important implications for counseling older women about urogynecologic surgery options, because elective surgeries to improve quality of life in these patients are increasingly common. “Elderly women should not be excluded from procedures that may improve their quality of life; however, it is appropriate to consider age alone when counseling women,” Dr. Sung said.

Of the study participants, 19% were aged 60–69 years, 16% were aged 70–79 years, and 4% were at least 80 years old.

The perioperative complication rate was 20% in those ages 80 and older, 16% for those aged 70–79, 13% for those aged 60–69, and 14% for those under age 60.

Mean length of stay in the hospital also was increased in the oldest group of patients (3.2 days among those 80 and older, vs. 2.4 days for the other groups).

Even after adjusting for comorbidity status, increased age was significantly associated with increased risk of in-hospital death and complications. For example, the adjusted odds ratio for in-hospital death was 13.8 among those aged 80 and older without comorbidities, and a similar trend was seen in women with any comorbidities, Dr. Sung noted.

The risk of complications was significantly lower among those aged 80 and older undergoing obliterative procedures, such as colpocleisis or colpectomy, compared with reconstructive procedures, such as vaginal vault suspension with or without hysterectomy (17% vs. 25% complication rate). The risk of in-hospital death with obliterative procedures also was lower in this population, though not significantly, she said.

Women included in the study were part of the National Inpatient Sample. Urogynecologic discharge diagnoses and procedural ICD-9 codes were used to identify those undergoing urogynecologic procedures. The patients had a mean of 2.8 procedures per admission, and this was similar across the age groups.

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