Association of Patient Age with Pelvic Organ Prolapse Surgery Choice and Adverse Events: A NSQIP Database Study

INTRODUCTION: Prolapse, urinary incontinence, and hysterectomy surgeries are common procedures among women, yet the influence of age on surgical outcomes remains underexplored. Understanding how age affects these interventions is crucial for optimizing care. OBJECTIVE: To determine if 30-day perioperative outcomes vary by age and, if so, whether specific pelvic organ prolapse (POP) or incontinence interventions have a lower risk of major or minor adverse events. METHODS: We conducted a retrospective cohort study of women who underwent POP or urinary incontinence surgery using the 2011–2022 American College of Surgeons National Surgical Quality Improvement Program database. Patients were categorized by age as 18–59, 60–69, 70–79, and 80+ years of age. CPT codes for procedures were grouped as “prolapse,” “urinary incontinence,” and “hysterectomy” procedures. For inclusion, subjects had to have a “prolapse” or “incontinence” CPT code. Patient demographics and rates of adverse events were analyzed. Major complications included a composite outcome of deep/organ space surgical site infection, wound dehiscence, pulmonary embolism, cardiac arrest, myocardial infarction, blood transfusion, deep venous thrombosis, blood transfusion, sepsis, septic shock, or stroke. Minor complications included a composite outcome of pneumonia, superficial surgical site infection, or urinary tract infection. Multivariate logistic regression models were used to assess the association between patient age and major/minor complications using age as a categorical factor and as a continuous feature through regression splines. RESULTS: We identified 179,459 women who met the inclusion criteria. Of these, 52% (93,354) were age <60, while only 4.5% (8,095) of the cohort was age 80+ (Table 1). Age 80+ was significantly associated with major complication on univariate age-based analysis (Table 1). Multivariate logistic regression for major complication was performed, controlling for procedure type, smoking, ASA classification, surgical specialty, outpatient surgical status, and the number of CPT codes (Table 2 for categorical age; Figure 1 for continuous age). Relative to age <60, patients age 60–69 and 70–79 had significantly lower rates of major complication (Table 2; age 60–69: aOR 0.69 [95% CI 0.64–0.75]; age 70–79: aOR 0.73 [0.66–0.79]); patients 80+ were not significantly more likely than patients age <60 to have major complication (aOR 0.98 [0.86–1.12]). Smoking, increasing ASA classification, increasing number of procedural CPT codes, and general surgery subspecialty were significantly associated with increased risk of major and minor complication in all age groups. Outpatient procedures were associated with a lower risk of major and minor complications. A sub-analysis was performed specifically examining the 70+ cohort undergoing prolapse repair with and without the performance of an obliterative procedure. The obliterative versus non-obliterative groups were found to not be significantly different in the rate of major and minor complication. CONCLUSIONS: This data shows no significant difference in the complication rate based on age and no benefit in risk reduction through the use of obliterative procedures in individuals >70. Surgical planning should be tailored to patient goals rather than being based on age alone.