Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes
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ORIGINAL ARTICLE – HEALTH SERVICES RESEARCH AND GLOBAL ONCOLOGY
Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes Alessia Aloisi, MD1,2, Jill Tseng, MD1,3, Theresa Kuhn, MD1,4, Jacqueline Feinberg, MD1, Dennis S. Chi, MD1,5, Carol L. Brown, MD1,5, Jennifer J. Mueller, MD1,5, Ginger J. Gardner, MD1,5, Oliver Zivanovic, MD1,5, Elizabeth L. Jewell, MD1,5, Kara Long Roche, MD1,5, Vance Broach, MD1,5, Nadeem R. Abu-Rustum, MD1,5, and Mario M. Leitao Jr., MD1,5 1
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2Present Address: European Institute of Oncology, Milan, Italy; 3Present Address: University of California, Irvine, Irvine, CA; 4 Present Address: Emory University School of Medicine, Atlanta, GA; 5Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
ABSTRACT Purpose. The frail are considered at higher risk for unfavorable surgical outcomes (major complications/mortality). We assessed the safety of and outcomes associated with robotic surgery in the frail elderly undergoing gynecologic procedures. Methods. We identified patients aged C 65 years who underwent a robotic procedure between May 2007 and December 2016. Frailty was defined as the presence of at least three of five frailty factors—more than five comorbidities, low physical activity, weight loss, exhaustion, and fatigue. Perioperative outcomes were recorded. We compared variables among frail and non-frail patients and performed a multivariate logistic regression to detect variables associated with major complications (C grade 3) or 90-day mortality. Results. We identified 982 patients: 71 frail and 911 nonfrail patients. Median age was 71 years. Median BMI was 29.8 kg/m2. Thirty-four patients (3.5%) had a 30-day readmission. Seventy-seven (7.8%) had a postoperative complication, of which 23 (2.3%) were major. Ninety-day mortality was 0.5%. There were significant differences with regard to age (P \ 0.001), body mass index (BMI) (P \ 0.001) and performance status (P \ 0.001); the frail
Ó Society of Surgical Oncology 2020 First Received: 6 January 2020 M. M. Leitao Jr., MD e-mail: [email protected]
were more likely to have had surgery for oncologic reasons (P = 0.047). There were differences in hospital stay (P \ 0.001), postoperative (P = 0.042) and major complications (P = 0.007), and 90-day mortality (P = 0.05). At multivariable logistic regression, age C 85 was associated with major complications. BMI, performance status, and major complications were associated with 90-day mortality. Conclusions. The frail elderly have longer hospital stays and more complications after surgery than the general population, consistent with the reported literature. Careful selection of surgical candidates is required.
The elderly population is expanding exponentially. In the United States, individuals aged 65 years or older will account for approximately 20% of the population by the year 2030. Over the same time period, the number of individuals older than 75 years is
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