Alireza Hadizadeh, Henry H Chill, Angela Leffelman, Claudia Paya-Ten, Cecilia Chang, Jungeun Lee, Roger P Goldberg, Ghazaleh Rostaminia
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引用次数: 0
Abstract
Objective: To assess the risk of postoperative complications and unanticipated healthcare encounters in octogenarians compared to younger patients following apical prolapse repair.
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 to 79 (younger cohort). Patients who underwent obliterative procedures or had missing complication data within 30 days postsurgery 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 < .001) and a history of deep vein thrombosis (6.7% vs 1.7%, p < .001), compared to younger patients. However, overall complication frequency within 30 days did not differ significantly between groups (7.4% vs 7.6%, p = .934). Specific complications varied, with octogenarians experiencing higher frequency of postoperative urinary retention (5.2% vs 0%, p < .001), and younger patients showing a higher likelihood of urinary tract infections (5.9% vs 0.7%, p = .013). Multivariate analysis identified prior abdominal surgery (OR: 2.20, 95% CI: 1.05-4.57, p = .036) and undergoing anterior repair (OR: 3.36, 95% CI: 1.27-8.89, p = .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.
目的：比较八旬老人与年轻患者在根尖脱垂修复术后发生并发症和意外医疗事故的风险。设计：回顾性队列研究。单位：学校附属三级专科医院中心。干预：盆腔器官脱垂患者的手术：2009年至2024年间接受根尖脱垂修复的患者。队列分为两组：1)80岁以上患者（80岁以上）；2) 18-79岁患者（年轻队列）。在手术后30天内进行了闭塞手术或缺少并发症资料的患者被排除在外。测量方法及主要结果：共分析481例患者，其中老年患者136例，年轻患者355例。术后30天内的并发症是主要结局，而次要结局包括意外的医疗保健遭遇，如急诊科就诊、诊所就诊和再入院。与年轻患者相比，80多岁患者的合并症发生率明显更高，如高血压（61.5% vs. 28.1%, p < 0.001）和深静脉血栓形成史（6.7% vs. 1.7%, p < 0.001）。然而，30天内的总并发症发生率在两组间差异无统计学意义（7.4% vs 7.6%, p = 0.934）。具体的并发症各不相同，八十多岁的患者术后尿潴留的发生率更高（5.2%比0%，p < 0.001），年轻患者尿路感染的可能性更高（5.9%比0.7%,p = 0.013）。多因素分析发现，既往腹部手术（OR: 2.20, 95% CI: 1.05-4.57, p = 0.036）和前路修复（OR: 3.36, 95% CI: 1.27-8.89, p = 0.015）是30天内并发症的预测因素。未预料到的医疗保健遭遇在两组之间没有显著差异。结论：老年患者根尖脱垂修复术是安全可行的，并发症发生率和就诊情况与年轻患者相似。这些发现表明，尽管个体化风险评估仍然至关重要，但年龄本身不应排除对这一人群进行手术干预。
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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