Assessment of peri- and post-operative outcomes following apical prolapse repair in octogenarians: A retrospective cohort study.

Abstract

Objective: To assess the risk of postoperative complications and unanticipated healthcare encounters in octogenarians compared to younger patients following apical prolapse repair.

Design: Retrospective cohort study.

Settings: University-affiliated academic tertiary hospital center.

Intervention: Surgery for pelvic organ prolapse PATIENTS: Patients who underwent apical prolapse repair between 2009 and 2024. The cohort was divided into two groups: 1) Patients over the age of 80 (octogenarians); 2) Patients aged 18-79 (younger cohort). Patients who underwent obliterative procedures or had missing complication data within 30 days post-surgery were excluded.

Measurements and main results: A total of 481 patients were analyzed, including 136 octogenarians and 355 younger patients. Postoperative complications within 30 days were the primary outcome, while secondary outcomes included unanticipated healthcare encounters such as emergency department visits, clinic visits, and readmissions. Octogenarians had significantly higher frequency of comorbidities, such as hypertension (61.5% vs. 28.1%, p < 0.001) and a history of deep vein thrombosis (6.7% vs. 1.7%, p < 0.001), compared to younger patients. However, overall complication frequency within 30 days did not differ significantly between groups (7.4% vs. 7.6%, p = 0.934). Specific complications varied, with octogenarians experiencing higher frequency of postoperative urinary retention (5.2% vs. 0%, p < 0.001), and younger patients showing a higher likelihood of urinary tract infections (5.9% vs. 0.7%, p = 0.013). Multivariate analysis identified prior abdominal surgery (OR: 2.20, 95% CI: 1.05-4.57, p = 0.036) and undergoing anterior repair (OR: 3.36, 95% CI: 1.27-8.89, p = 0.015) as predictors of complications within 30 days. No significant differences were observed in unanticipated healthcare encounters between groups.

Conclusion: Apical prolapse repair in octogenarians is safe and feasible, with similar complication frequencies and healthcare encounters compared to younger patients. These findings suggest that age alone should not preclude surgical intervention in this population, though individualized risk assessment remains crucial.