Association Between Advanced Age and Perioperative Complications Among Women Operated for Pelvic Organ Prolapse in Urogynecology Camps in Uganda

Abstract

Background: The burden of pelvic organ prolapse (POP) is the highest among elderly women compared to their young and middle-aged counterparts. These women are also faced with various medical comorbidities. Surgery in these women presents a challenge due to the increased risk of perioperative complications, especially in low-resource settings. Therefore, this study aimed to determine the association between advanced age and perioperative complications among women undergoing POP surgery in a resource-limited setting. Methods: This was a retrospective review of records for women who had surgery for POP during urogynecology camps conducted over a four-year period from January 2022 to December 2025 at eight centers in Uganda. A woman was considered elderly if she was aged 70 years and above. Perioperative complications assessed included intraoperative injury to pelvic viscera, duration of hospital stay, and in hospital adverse events. We compared the proportions of perioperative complications in the elderly and nonelderly using a chi-square test. Cramér's V coefficient was used to assess effect size. Bivariate and multivariate modified Poisson regression analyses were done to determine the association between advanced age and perioperative complications. The level of statistical significance was set at < 0.005). The overall prevalence of perioperative complications was 14.26% (n = 78, CI: 11.57-17.46). There was no significant difference in the proportion of perioperative complications between the two groups (10/63, 15.9% vs. 68/484, 14.1%) (p = 0.697). At the multivariate analysis, advanced age was not associated with perioperative complications (aPR 1.07; CI: 0.57- 2.03; p = 0.828). Conclusions: Advanced age was not associated with perioperative complications. We recommend that surgery be offered as a viable option to elderly women with POP in urogynecological surgical camps and enhanced recovery after surgery measures be implemented by POP surgeons