Perioperative Safety of Surgery for Pelvic Organ Prolapse in Elderly and Frail Patients.
Aged; Humans; Female; Aged 80 and over; Middle Aged; Postoperative Complications/etiology; Gynecologic Surgical Procedures/adverse effects; Patient Safety; Frailty/complications; Pelvic Organ Prolapse/surgery; Perioperative Period
OBJECTIVE: To evaluate the effects of old age and frailty on complication rates after surgery for pelvic organ prolapse. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent surgery for prolapse from 2010 to 2017. We compared our control group (45-64 years, index population) to those aged 65-79 years (elderly) and 80 years and older (very elderly). Frailty was assessed using the National Surgical Quality Improvement Program Modified Frailty Index-5. The primary outcome was the composite rate of serious complications and mortality. RESULTS: We analyzed 27,403 patients in the index population, 20,567 in the elderly group, and 3,088 in the very elderly group. The composite rate of serious complications in the index population was 4.5%, compared with 4.7% in the elderly group (odds ratio [OR] 1.0, 95% CI 0.9-1.1) and 9.0% in the very elderly group (OR 2.1, 95% CI 1.8-2.4). Compared with the index group, the very elderly group had notably elevated risks of cardiac complications (OR 11.9, 95% CI 6.2-23.0), stroke (OR 26.6, 95% CI 5.4-131.8), and mortality (OR 39.9, 95% CI 8.6-184.7). On multivariate logistic regression, the only age group independently associated with serious complications was the very elderly group (adjusted odds ratio [aOR] 2.01, 95% CI 1.8-2.3). The Modified Frailty Index-5 score was independently predictive of complications (aOR 1.4, 95% CI 1.1-2.0). Stratified analysis using interaction terms revealed the Modified Frailty Index-5 score to be predictive of complications in the elderly age group (aOR 2.5, 95% CI 1.3-4.6), but not in the very elderly group. CONCLUSION: Serious complications surrounding prolapse surgery increase substantially in the cohort of patients older than 80 years of age, independent of frailty and medical or surgical risk factors.
Chapman GC; Sheyn D; Slopnick EA; Hijaz AK; Mahajan ST; Mangel J; El-Nashar SA
Obstetrics and Gynecology
2020
2020-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/aog.0000000000003682" target="_blank" rel="noreferrer noopener">10.1097/aog.0000000000003682</a>
Preoperative testing for urethroplasty is not associated with outcomes - A NSQIP study.
Urethra; Health policy; Complications; Perioperative period; Preoperative care
OBJECTIVE: To assess the current practice of routine preoperative testing before urethroplasty and to determine if the results are clinically significant. METHODS: Data was obtained from the National Surgical Quality Improvement Program (NSQIP) database. We identified 1,527 patients who underwent urethroplasty from 2010 to 2017. Chi square and one-way ANOVA tests were used to compare categorical and continuous variables, respectively. Multivariable logistic regression analyses were utilized to assess the rate of complications between testing groups. RESULTS: A total of 8,455 individual laboratory tests were performed on 1,156 patients (average of 7 tests per patient), with only 959 labs (11.3%) showing abnormal results. Of the 1,156 patients, 629 (54.4%) patients had at least one abnormal lab. Patients who had at least one abnormal preoperative lab were found to be significantly older (51.49+/-16.57 years vs. 48.14+/-16.32 years; p<0.001), and to be smokers (112 (17.8%) vs. 63 (12%); p=0.005). Additionally, they were more likely to have diabetes mellitus (112 (17.8%) vs. 63 (12%); p<0.001), dyspnea (18 (2.9%) vs. 16(3.0%); p=0.029), and ASA class >/=3 when compared to the group with normal preoperative labs. On a multivariable logistic regression, abnormal preoperative tests were not predictive of intra- or postoperative complications in patients with ASA /= 3, the only lab predictive of postoperative complications was an abnormal coagulation profile. CONCLUSION: Obtaining routine preoperative labs, especially in patients with ASA
Mishra Kirtishri; Avila Amanda; Mahran Amr; Raina Richa; Sidagam Vasu; Ponsky Lee E; Gonzalez Chris M; Bukavina Laura
Urology
2020
2020-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.urology.2020.02.018" target="_blank" rel="noreferrer noopener">10.1016/j.urology.2020.02.018</a>