Don't discount gynecologic surgeries for elderly: risk of major procedures could be reduced by attending to group's specific perioperative needs.(Gynecology)

SAN FRANCISCO -- Elderly women should not be denied major gynecologic surgery solely on the basis of their presumed age-based operative risk, according to Lindsay M. Mains, M.D.

In a study she presented at the annual meeting of the American College of Obstetricians and Gynecologists, Dr. Mains showed morbidity and mortality among elderly women undergoing major gynecologic surgery is high, compared with rates in younger women undergoing this surgery. But attention to specific perioperative needs of the elderly might reduce this risk, said Dr. Mains of the Ochsner Clinic Foundation in New Orleans.

Dr. Mains' study reviewed data from 110 major gynecologic surgeries on women aged 80-90 years old. All patients received preoperative medical clearance, except one who required emergent surgery.

Although half of the patients were overweight or obese, 61% had no serious medical history otherwise, and 96% had an American Society of Anesthesiologists' (ASA) score of 3 or less.

Most procedures (77%) were performed to remove cancer or a benign mass; the rest were undertaken to treat pelvic organ prolapse and/or urinary incontinence. Almost all patients (95.5%) received general endotracheal anesthesia.

An abdominal procedure was performed in 65% of patients, while 32.5% underwent laparoscopy. A total of 4.5% had a vaginal procedure.

Dr. Mains reported an intraoperative complication rate of 4% and a postoperative complication rate of 45%. Eight percent of the total study group had major life-threatening complications, including death in 3.6% of patients.