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Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies

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DOI: 10.4236/ss.2014.53018    3,157 Downloads   4,083 Views   Citations

ABSTRACT

Objective: To estimate the impact of patient’s age on surgical outcomes in patients undergoing robotic hysterectomy. Methods: A retrospective review of prospectively collected cohort data for a consecutive series of patients undergoing gynecologic robotic surgery. Patient’s age and perioperative variables were collected from the database, charts, and other hospital records of all patients undergoing robotic hysterectomy. Results: 399 patients underwent robotic surgery for gynecologic disease. 370 patients who were under age 70 were compared with 29 patients who were over age 70. When comparing all patients under age 70 with patients over age 70, the mean age was 48.4 and 77 (P < 0.05), mean BMI was 32.1 and 28.3 kg/m2 (P < 0.05), mean procedure time was 185 and 211 minutes (min) (P = 0.09), mean console time was 123 and 148 min (P = 0.056), mean OR (Operating room) time was 237 and 273, mean EBL (Estimated blood loss) was 71 and 65 ml (P = 0.74), Hb (Hemoglobin) drop was 1.4 and 1.2 (P = 0.45), uterine weight was 212 and 95 gm (P = 0.98), and length of stay was 1.4 and 1.6 days (P = 0.33) (Table 1). The patients over age 70, when procedures were combined, had a statistically significant lower mean BMI, uterine weight and longer Operating room (OR) time. However, when stratified by the type of procedure performed, there was no difference in surgery times among those under 70 and over 70 years of age. The elderly patients were more likely to have cancer, which was in almost half the elderly patients, and thus necessitate staging. Thus adding the performance of lymph node dissection likely resulted in the increased length of the surgery time that was noted in the combined group (Tables 1,2). There were no operative deaths. Conclusions: Advanced age does not appear to be associated with an increased risk of morbidity, or adverse perioperative outcomes in patients undergoing robotic hysterectomy.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Eddib, A. , Hughes, S. , Aalto, M. , Eswar, A. , Erk, M. , Michalik, C. , Krovi, V. and Singhal, P. (2014) Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies. Surgical Science, 5, 90-96. doi: 10.4236/ss.2014.53018.

References

[1] Lee, M., et al. (2011) Comparisons of Surgical Outcomes, Complications, and Costs between Laparotomy and Laparoscopy in Early-Stage Ovarian Cancer. International Journal of Gynecological Cancer, 21, 251-256. http://dx.doi.org/10.1097/IGC.0b013e318208c71c
[2] Kalogiannidis, I., et al. (2007) Laparoscopy-Assisted Vaginal Hysterectomy Compared with Abdominal Hysterectomy in Clinical Stage I Endometrial Cancer: Safety, Recurrence, and Long-Term Outcome. American Journal of Obstetrics & Gynecology, 196, e1-8.
[3] Nezhat, C., et al. (2009) Laparoscopic Hysterectomy with and without a Robot: Stanford Experience. JSLS, 13, 125-128.
[4] Soto, E., et al. (2011) Total Laparoscopic Hysterectomy versus da Vinci Robotic Hysterectomy: Is Using the Robot Beneficial? Journal of Gynecologic Oncology, 22, 253-259. http://dx.doi.org/10. 3802/jgo.2011.22.4.253
[5] Payne, T.N. and Dauterive, F.R. (2008) A Comparison of Total Laparoscopic Hysterectomy to Robotically Assisted Hysterectomy: Surgical Outcomes in a Community Practice. Journal of Minimally Invasive Gynecology, 15, 286-291. http://dx.doi.org/10.1016/j.jmig.2008.01.008
[6] Wu, J.M., et al. (2007) Hysterectomy Rates in the United States, 2003. Obstetrics & Gynecology, 110, 1091-1095. http://dx.doi.org/10.1097/01.AOG.0000285997.38553.4b
[7] Merrill, R.M. (2008) Hysterectomy Surveillance in the United States, 1997 through 2005. Medical Science Monitor, 14, CR24-31.
[8] Efron, D.T. and Bender, J.S. (2001) Laparoscopic Surgery in Older Adults. Journal of the American Geriatrics Society, 49, 658-663. http://dx.doi.org/10.1046/j.1532-5415.2001.49130.x
[9] Nezhat, C., et al. (2009) Robot-Assisted Laparoscopic Surgery in Gynecology: Scientific Dream or Reality? Fertility and Sterility, 91, 2620-2622. http://dx.doi.org/10.1016/j.fertnstert.2008.03.070
[10] Yoshikawa, T.T. (2012) Future Direction of Geriatrics: “Gerogeriatrics”. Journal of the American Geriatrics Society, 60, 632-634. http://dx.doi.org/10.1111/j.1532-5415.2012.03896.x
[11] Leung, J.M. and Dzankic, S. (2001) Relative Importance of Preoperative Health Status versus Intraoperative Factors in Predicting Postoperative Adverse Outcomes in Geriatric Surgical Patients. Journal of the American Geriatrics Society, 49, 1080-1085. http://dx.doi.org/10.1046/j.1532-5415. 2001.49212.x
[12] Ramesh, H.S., et al. (2005) Optimising Surgical Management of Elderly Cancer Patients. World Journal of Surgical Oncology, 3, 17. http://dx.doi.org/10.1186/1477-7819-3-17
[13] Atiemo, H., Griebling, T.L. and Daneshgari, F. (2006) Advances in Geriatric Female Pelvic Surgery. BJU International, 98, 90-96. http://dx.doi.org/10.1111/j.1464-410X.2006.06301.x
[14] Lau, S., et al. (2011) Relationship between Body Mass Index and Robotic Surgery Outcomes of Women Diagnosed with Endometrial Cancer. International Journal of Gynecological Cancer, 21, 722-729. http://dx.doi.org/10.1097/IGC.0b013e318212981d
[15] Vaknin, Z., et al. (2010) Outcome and Quality of Life in a Prospective Cohort of the First 100 Robotic Surgeries for Endometrial Cancer, with Focus on Elderly Patients. International Journal of Gynecological Cancer, 20, 1367-1373.
[16] Falabella, A., et al. (2007) Cardiac Function during Steep Trendelenburg Position and CO2 Pneumoperitoneum for Robotic-Assisted Prostatectomy: A Trans-Oesophageal Doppler Probe Study. International Journal of Medical Robotics, 3, 312-315. http://dx.doi.org/10.1002/rcs.165
[17] Lestar, M., et al. (2011) Hemodynamic Perturbations during Robot-Assisted Laparoscopic Radical Prostatectomy in 45 Degrees Trendelenburg Position. Anesthesia & Analgesia, 113, 1069-1075. http://dx.doi.org/10.1213/ANE.0b013e3182075d1f
[18] Halverson, A., et al. (1998) Evaluation of Mechanism of Increased Intracranial Pressure with Insufflation. Surgical Endoscopy, 12, 266-269. http://dx.doi.org/10.1007/s004649900648
[19] Casati, A., et al. (2007) Monitoring Cerebral Oxygen Saturation in Elderly Patients Undergoing General Abdominal Surgery: A Prospective Cohort Study. European Journal of Anaesthesiology, 24, 59-65.
[20] Kalmar, A.F., et al. (2010) Influence of Steep Trendelenburg Position and CO(2) Pneumoperitoneum on Cardiovascular, Cerebrovascular, and Respiratory Homeostasis during Robotic Prostatectomy. British Journal of Anaesthesia, 104, 433-439. http://dx.doi.org/10.1093/bja/aeq018
[21] Awad, H., et al. (2009) The Effects of Steep Trendelenburg Positioning on Intraocular Pressure during Robotic Radical Prostatectomy. Anesthesia & Analgesia, 109, 473-478. http://dx.doi.org/10.1213/ ane.0b013e3181a9098f
[22] Weber, E.D., et al. (2007) Posterior Ischemic Optic Neuropathy after Minimally Invasive Prostatectomy. Journal of Neuro-Ophthalmology, 27, 285-287. http://dx.doi.org/10.1097/WNO.0b0 13e31815b9f67
[23] Vaknin, Z., et al. (2010) Outcome and Quality of Life in a Prospective Cohort of the First 100 Robotic Surgeries for Endometrial Cancer, with Focus on Elderly Patients. International Journal of Gynecological Cancer, 20, 1367-1373.

  
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