MORBIDITY AND MORTALITY OF ELECTIVE GYNECOLOGIC SURGERY IN THE ELDERLY WOMAN

Marc R. Toglia, MD and Thomas E. Nolan, MD


   Objective: To report perioperative morbidity and mortality in women age 70 years and older who underwent elective gynecologic surgery.

   Materials and Methods: The charts of 50 consecutive women ages 70 – 85 who underwent elective gynecologic surgery between June 1998 and September 2002 were retrospectively reviewed. All women were cared for by a single surgeon (MRT). Variables considered included type and route of the procedure, type of anesthesia, operative time, blood loss, length of stay, preoperative co-morbid disease, and intraoperative and postoperative complications.

   Results: The mean age of the patients is 76.77 years. Eleven women (18%) had a history of significant coronary heart disease, three had a history of prior CVA, and three had a chronic pulmonary disorder. Forty-six procedures (92%) were performed for pelvic organ prolapse and/or urinary incontinence, two for gynecologic malignancies, and two for pelvic masses. Forty-six of the procedures were performed from the vaginal approach, and 25 (49%) were performed under general anesthesia. The incidence of intraoperative complications was 10% (2 cystotomies, 1 proctotomy, 1 EBL>500cc, 1 allergic reaction to antibiotics). Postoperative cardiac complications occurred in 5 patients (10%) including 3 myocardial infarctions, two of which (3.92%) were fatal. Both fatalities occurred in women over the age of 80 and who had a prior history of coronary heart disease. The third patient was readmitted to the hospital after an MI on postoperative day 5. Other complications included ben! ign cardiac arrythmias in 2 patients (4%), slow return of GI function in 5 (10%), and transient mental status changes in two patients. Mean length of stay was 3.57 days.

   Conclusions: Postoperative complications among elderly women undergoing gynecologic surgery occurred at a rate that is similar to what has been reported in other surgical specialties. Although age alone is not a contraindication to elective gynecologic surgery, there are increased risks for the geriatric woman.