A COMPARATIVE-STUDY OF POSTOPERATIVE COMPLICATIONS ASSOCIATED WITH THE MODIFIED INDIANA POUCH IN ELDERLY VERSUS YOUNGER PATIENTS

Purpose: We defined the nature and risk of complications associated wi th the modified Indiana pouch in patients older than 75 years. Materia ls and Methods: We analyzed the clinical. course of 25 elderly patient s and a control group of 25 selected randomly from the cohort of those younger than 75 years. All patients underwent the modified Indiana po uch procedure. Charts were reviewed for type of operation, mean patien t age, length of hospital stay, medical conditions, and early and late morbidity and mortality. Comparisons were made between the 2 groups. Results: Simultaneous cystectomy or anterior exenteration was performe d in 84% and 95% of patents in the elderly and younger groups, respect ively. Mean age was 78.5 years in the elderly and 59.3 years in the yo unger group. Medical illnesses and early postoperative complication ra tes did not differ significantly between the 2 groups. Mean hospital s tay was increased but not significantly in the elderly group (12.4 ver sus 11.1 days). There were 2 perioperative deaths in the elderly group (8%) and 1 in the control group (4%). Mean followup was 24.5 months ( range 4 to 64) in the elderly versus 29.5 months (range 6 to 69) in th e younger group. Late complications with the pouch were also similar ( 16% in the elderly and 12% in the control group). Of the elderly patie nts 9 died (intercurrent medical disease in 1 and cancer progression i n 8) compared to 4 in the younger group (intercurrent medical disease in 1 and cancer progression in 3). Of the elderly patients 13 are aliv e (mean age 81 years) with a well functioning continent diversion. Con clusions: The modified Indiana pouch can be created with acceptable po stoperative morbidity and mortality in elderly patients, and it provid es an excellent functional result.