Analysis Of Senile Gynecologic Patients’ Comorbidities During Perioperative Period

Objective: This retrospective study used data from the First Hospital of JilinUniversity on patients aged over60years old hospitalized for gynecological surgeryduring January1st2012to December31th2014, aiming to know the followingfeatures of these cases: disease types, clinical features, preoperative comorbidities, theimpact of comorbidities to the perioperative period and the postoperativecomplications. We believe that our study will contribute to getting safer and moreeffective treatments for senile women.Methods: All data was collected from628gynecologic patients aged over60years old treated with surgery in the First Hospital of Jilin University from January1st2012to December31th2014, and carry out a retrospective analysis and grouping withcontrol for comparision to analyze the clinical data using chi-square test andnonparametric test as statistical methods. The following are the subjects we study:1.The disease types of senile gynecologic women treated with surgery.2.The comorbidities of senile gynecologic women in perioperative period.3.The related factors of senile gynecologic women’s comorbidities inperioperative period.4.The impact of senile gynecologic women’s comorbidities during perioperativeperiod.5.The comparison of the complications of gynecologic female patients who withcomorbidities and those who without.Results:1. Disease types. There are628senile gynecologic patients aged over60yearsold treated with surgery in the First Hospital of Jilin University from January1st2012to December31th2014, of which439cases are benign disease, accounting for the 69.9%,189cases are malignant tumors, accounting for the other30.1%. The mostcommon surgical disease is benign ovarian disease (22.6%), followed by endometrialbenign lesions (15.1%), when the third place is ovarian cancer (12.3%). Withinpatients with comorbidities, the main diseases required gynecological surgery arebenign ovarian tumors (24.5%), endometrial benign lesions (16.6%) and pelvic floordysfunction (10.2%). Among patients without comorbidities, the main diseases ofgynecological surgery are ovarian cancer (18.1%), benign ovarian tumors (18.1%) andendometrial cancer (16.5%). There are significant differences of disease typesbetween the patients with and without comorbidities. The most common diseases ofsenile benign gynecologic patients are benign ovarian tumors (32.3%), endometrialbenign lesions (21.6%) and pelvic floor dysfunction (13.9%). The most commondiseases of senile malignant gynecologic patients are ovarian cancer (40.7%),endometrial cancer (38.1%) and cervical cancer (17.5%).2. Comorbidities of senile gynecologic women in perioperative period. There are628cases senile gynecologic patients required surgery, when440cases of them havecomorbidities, accounting for the70.1%, and188cases without comorbidities,accounting for the rest29.9%. The top three most common comorbidities of senilegynecologic patients are cardiovascular disease (69.6%), endocrine disease (31.4%)and respiratory diseases (23.0%). The most common comorbidities of benign diseasepatients and malignant disease patients are cardiovascular disease, endocrine diseaseand respiratory disease, but there are more cases with endocrine diseases amongpatients with malignant diseases while there are more respiratory diseases andneurological diseases among those with benign diseases.3.The related factors of senile gynecologic patients’ comorbidities inperioperative period.(1) Age: The ages of all the patients are between60to85yearsold. The mean age of all patients is66.01±5.32years old and most of them are60to69years old. Patients with comorbidities are older than patients without comorbidities.This also applied to the patients in malignant group while there are no differencesbetween the ages of benign patients with or without comorbidities.(2) Occupation:The most common occupation of patients is non-manual work, while in no comorbidities group the rate of manual work patients is higher than comorbiditiesgroup, and in comorbidities group there are no differences of occupation betweenpatients with benign disease and malignant disease.(3) Living composition: In the628cases,372of the patients live in urban residence, accounting for the59.2%, when256live in rural, accounting for the rest40.8%. There are no differences in residencebetween the group of patients with comorbidities and the group of patients withoutcomorbidities, nor between patients have comorbidities with benign diseases andthose with malignant diseases.(4) Unhealthy lifestyle: There are no differences incomorbidities group and no comorbidities group of unhealthy lifestyle. Incomorbidities group, there are no differences between patients with benign ormalignant disease of unhealthy lifestyle.(5) Menstrual and obstetrical history: Thereare no differences between comorbidities group and no comorbidities group ofmenstrual obstetrical history.4.The impact of senile gynecologic patients’ comorbidities during perioperativeperiod.(1) Perioperative general information: There are no differences betweencomorbidities group and no comorbidities group of perioperative general information.Among patients with benign gynecologic disease, the preparation time before surgeryis longer in comorbidities group. In patients with malignant disease, there are nodifferences between comorbidities group and no comorbidities group of perioperativegeneral information.(2) Selection of operation: There are no differences betweencomorbidities group and no comorbidities groups of surgical option, but the choice ofminimally invasive surgery are different. Among benign gynecologic patients, thenumbers of comorbidities have no effect on operation selection. Compare to otheroperation, the hospital stay, preoperative preparation time, operative time,postoperative hospital stay are shorter in hysteroscopic surgery and also have lowermedical costs.(3) Post-operative recovery: There are differences of postoperativerecovery time between different operation. The postoperative recovery time ofhysteroscopic surgery is significantly shorter than other operations. Patients withcomorbidities need a longer recovery time than patients without comorbidities.Different comorbidities have different effects on post-operation recovery time. 5. The comparison of the complications of gynecologic female patients who withcomorbidities and those who without: Postoperative complications are not related topreoperative comorbidities. There are more complications in malignant group thanbenign group.Conclusions:1.The incidence of comorbidities of senile gynecologic patients is high. The mostcommon comorbidities of senile gynecologic patients who have surgery are cardio-vascular disease, endocrine diseases and respiratory diseases.2.In senile gynecologic patients who needed surgery, there are more benigndisease than malignant disease. There are more post-operative complications inmalignant disease, so we should focus on the perioperative management.3.Hysteroscopic surgery is more suitable for senile patients’ benign endometrialdisease.4. Focus on perioperative management of senile women can reduce the incidenceof postoperative complications and improve safety in perioperative period.