The effect of age on complications in women undergoing minimally invasive sacral colpopexy

Introduction and hypothesis: Previous research has demonstrated similar complication rates in older and younger women undergoing abdominal sacral colpopexy via laparotomy. The objective of this study was to compare perioperative complications in older and younger women undergoing minimally invasive sacral colpopexy. Methods: This was a retrospective study of laparoscopic and robotic sacral colpopexies performed from January 2009 to May 2012 at a large academic center. Patient demographics, surgical data, and perioperative complications were compared in women <65 and ≥65 years of age. Primary outcome was the difference in major complications. Results: A total of 302 women underwent minimally invasive sacral colpopexy during the study period. Mean age was 58.5±8.8 years and 84 subjects (27.8 %) were ≥65 years. Older women were more likely to have had a prior hysterectomy (60.7 vs 39.0 %, p=0.001) and had more severe preoperative prolapse (86.9 % vs 71.9 %≥ POPQ stage III, p=0.01). There was no significant difference in duration of hospitalization (1.4 vs 1.4 days, p=0.54). Overall, there were significantly more major complications in women ≥65 years (unadjusted OR 1.84, 95 % CI 1.02-3.35, p=0.04). After controlling for BMI, route of surgery, estimated blood loss (EBL), and operating room time, age ≥65 remained a significant predictor of complications (adjusted OR 2.28, 95 % CI 1.21-4.29, p=0.01). Conclusions: Our findings suggest that older women have a higher rate of major complications following minimally invasive sacral colpopexy, even after controlling for BMI, route of surgery, EBL, and operating room time. This increased risk should be addressed during preoperative counseling and may influence surgical planning.