Should we perform elective inguinal hernia repair in the elderly?

Area of Science:

• Surgical outcomes research
• Geriatric surgery
• Hernia repair epidemiology

Background:

• Surgeons often hesitate to perform elective inguinal and femoral hernia repair (IHR) in elderly patients due to perceived higher risks.
• This study evaluates the outcomes of IHR in elderly individuals compared to the general population.

Purpose of the Study:

• To compare the outcomes of elderly patients undergoing inguinal and femoral hernia repair (IHR) with those of the general population.
• To assess the impact of age, surgical approach, and comorbidities on mortality and complications in IHR.

Main Methods:

• Retrospective review of the 2011 NSQIP database, including 19,683 patients undergoing IHR.
• Patients categorized into three age groups: <65, 65-79, and >80 years.
• Logistic regression analysis to evaluate the influence of comorbidities and surgery type (elective, urgent, emergent, laparoscopic, open) on outcomes.

Main Results:

• Mortality rates for elective IHR were similar across all age groups.
• Emergency IHR demonstrated significantly increased mortality in all age groups, particularly in patients >80 years (OR=57).
• Comorbidities like dyspnea and COPD were associated with higher mortality and complications in elderly patients undergoing emergency surgery.

Conclusions:

• Elective inguinal and femoral hernia repair (IHR) is a safe procedure with comparable mortality rates in elderly patients.
• Emergent IHR in the elderly is associated with a substantially elevated risk of mortality.
• The findings support offering elective IHR to elderly patients irrespective of age.