Obstet Gynecol Sci.  2024 Mar;67(2):243-252. 10.5468/ogs.23238.

Advantages of laparoscopy in gynecologic surgery in elderly patients

• Na J
• Chung YE
• Jang IY
• Lee YY
• Kim TJ
• Lee JW
• Kim BG
• Chang CS
• Choi CH

• KMID: 2553432
• DOI: http://doi.org/10.5468/ogs.23238

Abstract

Objective
Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years.
Methods
We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type.
Results
Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar results were observed in cancer-only and benign-only cohorts.
Conclusion
Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.

Keyword

Minimally invasive surgical procedure; Gynecological surgery; Aged; Geriatric

Figure

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  Fig. 1 Flowchart of patient selection. Patient selection was done by DARWIN-C (data analytics and research window for integrated knowledge-clinical data).

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  Fig. 2 Comparison of surgical outcomes between the age groups by surgical approach with linear regression analysis. (A) Comparison of EBL (mL) between age groups by surgical approach. (B) Comparison of transfusion (pints) between age groups by surgical approach. (C) Comparison of operation time (minutes) between age groups by surgical approach. (D) Comparison of hospital stay (days) between age groups by surgical approach. EBL, estimated blood loss.

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  Fig. 3 Comparison of surgical outcomes between the age groups by surgical approach with linear regression analysis (cancer only). (A) Comparison of EBL (mL) between age groups by surgical approach (cancer only). (B) Comparison of transfusion (pints) between age groups by surgical approach (cancer only). (C) Comparison of operation time (minutes) between age groups by surgical approach (cancer only). (D) Comparison of hospital stay (days) between age groups by surgical approach (cancer only). EBL, estimated blood loss.

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  Fig. 4 Comparison of surgical outcomes between the age groups by surgical approach with linear regression analysis (benign only). (A) Comparison of EBL (mL) between age groups by surgical approach (benign only). (B) Comparison of transfusion (pints) between age groups by surgical approach (benign only). (C) Comparison of operation time (minutes) between age groups by surgical approach (benign only). (D) Comparison of hospital stay (days) between age groups by surgical approach (benign only). EBL, estimated blood loss.

Reference

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