Gynaecological Prolapse Surgery in Very Old Female Patients

Abstract

Background: The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. Method: In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Studentʼs t, Fisherʼs exact and Mann-Whitney U tests. Results: The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). Conclusions: A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities.

Zusammenfassung

Hintergrund: Ziel ist der Vergleich von hochaltrigen Patientinnen mit einer jüngeren Kontrollgruppe nach Deszensuschirurgie hinsichtlich Komorbidität und Komplikationen. Methode: Im Fallkontrolldesign erfolgte die Analyse konsekutiver Daten nach Deszensuschirurgie ab 80. Lebensjahr und einer Kontrollgruppe mittels Clavien-Dindo-(CD-)Klassifikation chirurgischer Komplikationen, Charlson Comorbidity Index und Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistik: Studentʼs t-, Fisherʼs Exact- und Mann-Whitney U-Tests. Ergebnisse: Es wurden n = 57 vs. n = 60 Operationen erfasst. Bei Hochaltrigen lag häufiger ein Grad-IV-Prolaps vor (p < 0,001), es erfolgte häufiger eine apikale Fixation (p < 0,001), die OP-Zeiten unterschieden sich nicht. Bei Hochaltrigen fanden sich 21 % CD-II + III-Komplikationen, in der Kontrollgruppe 6,6 % (p = 0,031). In beiden Gruppen traten keine CD-IV- und -V-Komplikationen auf, die Verweildauer lag bei 5 (± 1) vs. 4,1 (± 0,8; p < 0,001) Tagen, eine stationäre Weiterbetreuung erfolgte häufiger bei hochaltrigen Patientinnen (p < 0,001). Die Komorbidität Hochaltriger unterschied sich von der Kontrollgruppe in der Anzahl (median 2,0 vs. 1,5; p < 0,001), im CIRS-G (4,1 ± 2,2 vs. 2,4 ± 1,7; p < 0,001) und im Charlson-Index (1,6 ± 1,6 vs. 0,5 ± 0,7; p < 0,001). Schlussfolgerungen: Ein Deszensus kann bei hochaltrigen Patientinnen sicher chirurgisch versorgt werden. Komplikationen erreichten in keinem Fall Intensivtherapiepflichtigkeit oder Lebensbedrohlichkeit, führten aber zu einer verlängerten Verweildauer und häufiger zu geriatrischer oder internistischer stationärer Weiterbehandlung.

Key words

very elderly people - prolapse surgery - co-morbidity - surgical complications - Clavien-Dindo classification system

Schlüsselwörter

Hochaltrigkeit - Deszensuschirurgie - Komorbidität - chirurgische Komplikationen - Clavien-Dindo-Klassifikationssystem

• References

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