How Old Is Too Old? Safety of Minimally Invasive Gynecologic Surgery and Early Hospital Discharge in Elderly Women

Objective: With the increasing age of the population, more elderly women undergo gynecologic surgery. While multiple studies have demonstrated the advantages of minimally invasive surgery (MIS), there is a paucity of data regarding MIS in elderly women. This study was performed to evaluate outcomes among elderly women undergoing gynecologic MIS. Materials and Methods: For this retrospective cohort study, medical records were reviewed for patients ≥65 years old who underwent MIS performed by gynecologic oncologists at a single institution between 2009 and 2016. Outcomes among "younger-elderly" (ages 65-79) and "older elderly" (≥ age 80) patients were compared. Results: Two-hundred and ninety-eight patients, age ≥65, underwent MIS (younger-elderly = 268; older-elderly = 29). The median age in the younger-elderly was 69 (range: 65-79) and, in the older-elderly patients, 83 (range: 80-93). The older-elderly had more medical comorbidities than the younger-elderly patients (median Charlson index: 7 versus 5; p < 0.001). There was no significant difference between the 2 groups with respect to surgical approach, underlying malignancy, conversion to laparotomy, and hospital stay. There was also no significant difference between the younger- and older-elderly patients in rates of complications, or in 30- and 90-day readmissions. Conclusions: MIS with early discharge is a safe approach in elderly patients undergoing surgery performed by gynecologic oncologists. Elderly age should not prohibit consideration of MIS with early hospital discharge.