Association of Age With Adverse Events After Pelvic Organ Prolapse Surgery

Importance When treating pelvic organ prolapse (POP) through surgery, age may factor into joint decision making for surgeons and patients. Objective The objective of this study was to determine if 30-day perioperative outcomes after POP surgery vary by age. Study Design This was a retrospective cohort study of women who underwent surgery for POP using the 2011–2022 American College of Surgeons National Surgical Quality Improvement Program database. Composite rates of adverse events were categorized as major complications (deep/organ space surgical site infection [SSI], reintubation, renal failure, wound dehiscence, pulmonary embolism, cardiac arrest, myocardial infarction, deep vein thrombosis, sepsis, septic shock, return to operating room, stroke, and death) or minor complications (pneumonia, blood transfusion, superficial SSI, or urinary tract infection). Multivariate logistic regression models were used to assess the association between patient age and perioperative complications after adjusting for relevant variables. Interaction models were created to determine if age modulates the effect of procedure type (apical, nonapical, obliterative prolapse surgery) or concomitant hysterectomy on risk of complications. Results We included 133,058 women (aged 18–59 years, n=60,659, 45.6%; aged 60–69 years, n=37,818, 28.4%; aged 70–79 years, n=27,598, 20.7%; aged 80 years and older, n=6,983, 5.2%) who underwent POP surgical procedures. On multivariate logistic regression, relative to patients younger than 60 years, age groups 60–69 years and 70–79 years had significantly lower rates of major complications (60–69 years: adjusted odds ratio [aOR]=0.68 [0.62–0.74]; 70–79 years: aOR=0.71 [0.64–0.78]) and patients older than 80 years had similar rates of major complications (aOR=0.98 [0.86–1.12]). In the patients younger than 60 years, the addition of a hysterectomy to a prolapse procedure carried a slightly increased risk of major complications (aOR=1.19, 95% CI=1.06–1.32). No other group carried an increased risk of major complications when adding a hysterectomy or performing an apical or obliterative repair. Conclusion This study shows a low risk of complications after POP procedures, even in patients older than 80 years.