Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes

• Type of Material: Article
• Authors: Alessia Aloisi, Memorial Sloan Kettering Cancer Center; Jill Tseng, Memorial Sloan Kettering Cancer Center; Theresa Kuhn, Memorial Sloan Kettering Cancer Center; Jacqueline Feinberg, Memorial Sloan Kettering Cancer Center; Dennis S Chi, Memorial Sloan Kettering Cancer Center; Carol L Brown, Memorial Sloan Kettering Cancer Center; Jennifer J Mueller, Memorial Sloan Kettering Cancer Center; Ginger J Gardner, Memorial Sloan Kettering Cancer Center; Oliver Zivanovic, Memorial Sloan Kettering Cancer Center; Elizabth L Jewell, Memorial Sloan Kettering Cancer Center; Kara Long Roche, Memorial Sloan Kettering Cancer Center; Vance Broach, Memorial Sloan Kettering Cancer Center; Nadeem R Abu-Rustum, Memorial Sloan Kettering Cancer Center; Mario M Leitao, Memorial Sloan Kettering Cancer Center
• Language: English
• Date: 2020-04-23
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020, Society of Surgical Oncology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1245/s10434-020-08475-w
• Title of Journal or Parent Work: ANNALS OF SURGICAL ONCOLOGY
• Volume: 27
• Issue: 10
• Start Page: 3772
• End Page: 3780
• Grant/Funding Information: The study was funded in part by the National Institutes of Health/National Cancer Institute Memorial Sloan Kettering Cancer Center Support Grant (P30 CA008748).
• Keywords: Oncology; LAPAROSCOPIC HYSTERECTOMY; ENDOMETRIAL CANCER; PATIENT; UTERINE-CANCER; Surgery; OCTOGENARIANS; IMPACT; Science & Technology; Life Sciences & Biomedicine; METAANALYSIS; LAPAROTOMY; OLDER-ADULTS; AGE

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 ≥ 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 (≥ grade 3) or 90-day mortality. Results: We identified 982 patients: 71 frail and 911 non-frail 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 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 ≥ 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.