You’re How Old? Correlating Perioperative Complication Risk in Octogenarians Undergoing Colpocleisis for Pelvic Organ Prolapse
| Autor: | Amy Wozniak, Birte J. Wolff, Romina Sifuentes, Hayley C. Barnes, Elizabeth R. Mueller, Thythy Pham |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Urology Deep vein 030232 urology & nephrology Colpotomy Risk Assessment Pelvic Organ Prolapse 03 medical and health sciences Postoperative Complications 0302 clinical medicine Colpocleisis medicine Humans Correlation of Data Retrospective Studies Aged 80 and over 030219 obstetrics & reproductive medicine business.industry Age Factors Obstetrics and Gynecology Odds ratio Perioperative medicine.disease Thrombosis Confidence interval Surgery medicine.anatomical_structure Female Risk assessment business Complication |
| Zdroj: | Female Pelvic Medicine & Reconstructive Surgery. 27:238-243 |
| ISSN: | 2151-8378 |
| DOI: | 10.1097/spv.0000000000000759 |
| Popis: | Colpocleisis is a surgical treatment of pelvic organ prolapse for elderly women who are no longer sexually active. The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicts perioperative complications. We aim to determine if the NSQIP calculated risk correlates with true perioperative complications in women 80 years or older undergoing colpocleisis.Octogenarian women who underwent colpocleisis at our institution from 2007 to 2017 were included in this retrospective chart review. Medical comorbidities were entered into ACS NSQIP calculator, and the calculated risk was compared with actual complications.One hundred twenty-six octogenarians were included in the analysis. The true complication rate was higher than predicted by NSQIP (28.6% [36/126] vs 4.3% (SD, ±1.1%), which we attribute to our relatively high detection rate of urinary tract infection (32/36). Four patients (3.2%) had serious complications (pulmonary embolus, deep vein thrombosis, sepsis, and reintubation). In only 57% of cases, NSQIP risk calculation was concordant with true complication, showing significant departure from correct classification (P0.0001). The sensitivity and specificity of the NSQIP calculator were 66.7% and 53.3%, respectively. Multivariable analysis showed higher-than-predicted incidence of complications for patients requiring antiplatelet medication (Plavix or aspirin81 mg vs none; odds ratio, 4.84, 95% confidence interval, 1.72-13.60; P = 0.002) and a diagnosis of hypertension (odds ratio, 4.24; 95% confidence interval, 1.31-13.72; P = 0.016).Serious complication rates are low in octogenarians undergoing colpocleisis. The ACS NSQIP risk calculator does not strongly correlate with actual complications. Further refinement and evolvement of the database may improve its predictive value. |
| Databáze: | OpenAIRE |
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