Abstract: PD02-03
Sources of Funding: NIDDK K12 DK83021-07; K12 Urologic Research (KURe) Career Development Program, Pepper Center Research Career Development Core (RCDC) Advanced Scholar Award

Introduction

There are many surgical options for pelvic organ prolapse (POP) repairs spanning from obliterative procedures, such as colpocleisis, to reconstructive options including open abdominal, vaginal, and laparoscopic/robotic colpopexy. In theory, obliterative POP repairs would be ideally suited for frail older individuals due to their reported shorter operative time, lower blood loss, and faster recovery, however, this has yet to be demonstrated on a large national sample of women. The objective of this study was to determine whether frailty predicts the type of POP surgery performed (i.e., obliterative versus reconstructive) and the odds of postoperative complications among all types of POP procedures.

Methods

This is a retrospective cohort study of women undergoing obliterative and reconstructive surgery for POP in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2005 to 2013. We quantified frailty using the NSQIP Frailty Index (NSQIP-FI) and used logistic regression models predicting type of procedure (colpocleisis) and odds of post-operative complications.

Results

We identified a total of 12,731 women undergoing POP repairs, 5.3% of which were colpocleisis procedures, from 2005-2013. Among women undergoing colpocleisis, the average age was 79.2 years and 28.7% had a NSQIP-FI of 0.18 or higher, indicating frailty. Women undergoing colpocleisis procedures had higher odds of being frail (OR 1.9 95% CI 1.4-2.6 for NSQIP-FI 0.18 compared to NSQIP-FI 0) and were older aged (OR 486.2 95% CI 274.5-861.3 for age 85+ compared to <65). For all types of POP procedures, frailty increased the odds of complications (OR 1.5 95% CI 1.2-1.9 for NSQIP-FI 0.18 compared to NSQIP-FI 0), after adjusting for age and type of POP procedure.

Conclusions

For POP surgery, age is more strongly associated with the selection of a colpocleisis procedure than frailty, however, frailty is more strongly associated with postoperative complications than age for all types of POP procedures. Furthermore, surgeons may be basing their selection of type of POP procedure on age, whereas frailty may be a better predictor of outcomes. Furthermore, incorporating frailty into preoperative decision-making is important for improving expectations and outcomes among older women considering all types of POP surgery.

Funding

NIDDK K12 DK83021-07; K12 Urologic Research (KURe) Career Development Program, Pepper Center Research Career Development Core (RCDC) Advanced Scholar Award