Complication Rates Are Low for Women Aged 70 and Older Undergoing Sacrocolpopexy

Objectives: Aging is associated with multimorbidity and less resilience to surgical trauma, which may put patients at greater risk for adverse perioperative outcomes. We hypothesized that women undergoing minimally invasive sacrocolpopexy aged ≥70 years are more likely to experience adverse events (AE) within 8 weeks of surgery compared to their younger counterparts.

Methods: We performed a secondary analysis of a retrospective study on perioperative adverse events in women ≥61 years old undergoing prolapse surgery at a single academic center from January 2016 to May 2023. Only women undergoing minimally invasive sacrocolpopexy were included. The primary outcome was a composite 8-week AE outcome which included intraoperative complications, return to operating room, emergency room evaluation, re-admission, discharge to skilled nursing facility, cardiac complication, venous thromboembolism, surgical site infections, wound dehiscence, blood transfusion, hematoma, ileus or small bowel obstruction, postoperative urinary tract infection, death, and other complications. Secondary outcomes included prolapse recurrence and mesh complication. Demographic and clinical variables were compared between women aged 61-69 and older women (aged ≥70) using t-test (Mann-Whitney U) and chi-square analyses (Fisher’s exact). Multivariable logistic regression controlling for clinically relevant variables with p< 0.05 on univariate analyses were performed.

Results: Of the total cohort of 710 women, 29.7% (n=211) were aged ≥70 years. Older patients were more likely to have hypertension, diabetes, a history of cancer, and a higher Charlson Comorbidity Index (CCI) score (p < 0.05) (Table 1). They were significantly more likely to have had a prior incontinence surgery (p < 0.01). Older patients were less likely to undergo concomitant hysterectomy (p=0.02) and had shorter length of surgery (164.0±46.8min vs 180.3±49.1min, p< 0.01) with lower estimated blood loss (40 mL vs 35mL, p< 0.01).

On univariate analysis, older age was not significantly associated with 8-week perioperative AEs, nor was it associated with prolapse recurrence or mesh complication (Table 2). The composite AE outcome was not associated with older age on multivariable analysis, controlling for CCI score, surgical approach, and concomitant hysterectomy (adjusted odds ratio (aOR) 0.66, 95% confidence interval (CI) [0.39-1.10]). Women aged ≥70 had a 72% lesser odds of surgical site infections on multivariable analysis (aOR 0.28, 95% CI [0.08-0.95]).

Conclusions: In this select cohort undergoing minimally invasive sacrocolpopexy, age ≥70 years is not associated with perioperative AEs, prolapse recurrence, or mesh complication. Despite greater medical comorbidities, there were overall low rates of AE in this cohort of older patients. This finding of low AE rates in older patients highlights the safety profile of this surgical approach, an important consideration for urogynecologic surgeons caring for the aging population.