Operating on the Oldest-Old: Vaginal Prolapse Surgery Outcomes in Women Over 90

Abstract

IMPORTANCE: Women aged 90 years and older ("oldest-old") represent a small but growing population who may experience bothersome pelvic organ prolapse and opt for surgical repair. OBJECTIVE: This study aimed to compare perioperative adverse events (AEs) within 8 weeks of prolapse surgery between women ≥90 years and younger patients. STUDY DESIGN: We performed a secondary analysis of a dual-center retrospective cohort study of women ≥61 years old undergoing major prolapse surgery from January 2016 to May 2023. We identified all women ≥90 years and matched them to women <90 years in a 1:4 fashion based on Charlson Comorbidity Index score and surgery type. Matching was performed without replacement. The primary outcome was a composite AE outcome, defined as all intraoperative and postoperative complications within 8 weeks of surgery. RESULTS: There were 24 oldest-old undergoing prolapse surgery who were matched to 96 women with mean ± standard deviation age of 77.2 ± 5.7 years. Women ≥90 years were more likely to have a lower body mass index ( P < 0.01), greater preoperative prolapse stage ( P = 0.049), and were less likely to have general anesthesia ( P < 0.01). Patients did not differ in medical comorbidities, frailty status, concomitant hysterectomy or incontinence procedure, or length of postoperative stay. The oldest-old did not experience any intraoperative complications and had low rates of readmission (8.3%) and discharge to skilled nursing facilities (4.2%). Age ≥90 was not associated with composite AEs on multivariable analysis (adjusted odds ratio 1.60, 95% confidence interval [0.39-6.55]). CONCLUSIONS: Age ≥90 years does not appear to increase the risk of perioperative AEs in women with similar comorbidities.