Key result
Older female patients (≥65 years) undergoing robotic-assisted gynecological surgery had similar perioperative outcomes to younger patients, despite higher comorbidity scores (CCI 2.7 vs 1.5; p<0.001).
Why the study?
Due to demographic developments, the safety of minimally invasive robotic-assisted surgery in older female patients aged > 65 years with more preoperative comorbidities needed evaluation.
Does robotic-assisted gynecological surgery have similar perioperative outcomes in older patients compared to younger patients?
Cohort (n=242)
Yes
Does robotic-assisted gynecological surgery have similar perioperative outcomes in older patients compared to younger patients?
Robotic-assisted gynecological surgery is safe and feasible in older patients despite higher preoperative comorbidities, with perioperative outcomes comparable to younger patients.
May support robotic-assisted gynecological surgery in older patients with comorbidities; leaves open need for randomized confirmation of safety.
Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group < 65 years (younger age group, YAG) after robotic-assisted gynecological surgery (RAS) in two German centers. Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women’s University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale – geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch’s t-test, chi2 test, and Fisher’s exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p < 0.001), CIRS-G (9.7 ± 3.9 vs. 5.4 ± 2.9; p < 0.001), ASA class II/III (91.8% vs. 74.1%; p = 0.004), obesity (54.1% vs. 38.2%; p = 0.030). There was no difference between age groups, even grouped for benign or oncological indications, with regard to perioperative parameters such as duration of surgery (p = 0.088; p = 0.368), length of hospital stay (p = 0.786; p = 0.814), decrease in Hb levels (p = 0.811; p = 0.058), conversion rate (p = 1.000; p = 1.000) and CD complications (p = 0.433; p = 0.745). Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.
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Mothes et al. (2023) conducted a cohort in Benign or oncological gynecological conditions (n=242). Age ≥ 65 years vs. Age < 65 years was evaluated on Perioperative outcomes (duration of surgery, length of hospital stay, decrease in Hb levels, conversion rate, and Clavien-Dindo complications). Older female patients (≥65 years) undergoing robotic-assisted gynecological surgery had similar perioperative outcomes to younger patients, despite higher comorbidity scores (CCI 2.7 vs 1.5; p<0.001).
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