From the Loyola University Chicago Stritch School of Medicine.
Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, Maywood, IL.
Female Pelvic Med Reconstr Surg. 2021 Apr 1;27(4):238-243. doi: 10.1097/SPV.0000000000000759.
Colpocleisis is a surgical treatment of pelvic organ prolapse for elderly women who are no longer sexually active. The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicts perioperative complications. We aim to determine if the NSQIP calculated risk correlates with true perioperative complications in women 80 years or older undergoing colpocleisis.
Octogenarian women who underwent colpocleisis at our institution from 2007 to 2017 were included in this retrospective chart review. Medical comorbidities were entered into ACS NSQIP calculator, and the calculated risk was compared with actual complications.
One hundred twenty-six octogenarians were included in the analysis. The true complication rate was higher than predicted by NSQIP (28.6% [36/126] vs 4.3% (SD, ±1.1%), which we attribute to our relatively high detection rate of urinary tract infection (32/36). Four patients (3.2%) had serious complications (pulmonary embolus, deep vein thrombosis, sepsis, and reintubation). In only 57% of cases, NSQIP risk calculation was concordant with true complication, showing significant departure from correct classification (P < 0.0001). The sensitivity and specificity of the NSQIP calculator were 66.7% and 53.3%, respectively. Multivariable analysis showed higher-than-predicted incidence of complications for patients requiring antiplatelet medication (Plavix or aspirin >81 mg vs none; odds ratio, 4.84, 95% confidence interval, 1.72-13.60; P = 0.002) and a diagnosis of hypertension (odds ratio, 4.24; 95% confidence interval, 1.31-13.72; P = 0.016).
Serious complication rates are low in octogenarians undergoing colpocleisis. The ACS NSQIP risk calculator does not strongly correlate with actual complications. Further refinement and evolvement of the database may improve its predictive value.
阴道封闭术是一种针对不再有性生活的老年女性盆腔器官脱垂的手术治疗方法。美国外科医师学院国家外科质量改进计划（ACS NSQIP）的风险计算器可预测围手术期并发症。我们旨在确定 80 岁或以上接受阴道封闭术的女性中，NSQIP 计算的风险是否与真实围手术期并发症相关。
对 2007 年至 2017 年在我院接受阴道封闭术的 80 岁以上女性进行回顾性图表分析。将合并症输入 ACS NSQIP 计算器，并将计算出的风险与实际并发症进行比较。
共有 126 名 80 岁以上的女性被纳入分析。真实并发症发生率高于 NSQIP 预测值（28.6%[36/126] vs 4.3%[SD，±1.1%]，我们归因于我们相对较高的尿路感染检出率（32/36）。4 名患者（3.2%）发生严重并发症（肺栓塞、深静脉血栓形成、败血症和重新插管）。在仅 57%的病例中，NSQIP 风险计算与真实并发症一致，显示出与正确分类的显著偏离（P<0.0001）。NSQIP 计算器的灵敏度和特异性分别为 66.7%和 53.3%。多变量分析显示，需要抗血小板药物（Plavix 或阿司匹林>81mg 与无抗血小板药物相比；比值比，4.84；95%置信区间，1.72-13.60；P=0.002）和高血压诊断（比值比，4.24；95%置信区间，1.31-13.72；P=0.016）的患者并发症发生率高于预期。
行阴道封闭术的 80 岁以上患者严重并发症发生率较低。ACS NSQIP 风险计算器与实际并发症相关性不强。进一步完善和发展数据库可能会提高其预测价值。
