Critical differences among stakeholders in definitions of success following inguinal hernia repair in older adults

Inguinal hernia repair is one of the most common elective operations performed in adults aged 65 years and older, but there is little information on how different groups of stakeholders define successful inguinal hernia repair. The purpose of this study was to compare how older veterans, surgeons, anesthesiologists, and Veterans Affairs leadership define success after inguinal hernia surgery.

Semistructured interviews and focus groups explored the relative importance of several hernia-related outcomes with 40 veterans aged ≥65 years who recently underwent inguinal hernia repair, 10 surgeons, 9 anesthesiologists, and 7 Veterans Affairs hospital leaders.

The mean age of veteran participants was 73 years. All were male, 65% were White, and 33% were Black. Surgeons, anesthesiologists, and hospital leaders were 69% male. For veterans, the 3 most important outcomes defining successful hernia surgery were avoiding postoperative urinary retention, returning to normal physical function within 2 months of surgery, and minimizing cognitive dysfunction. For surgeons, the most important outcomes were returning to normal within 2 months after surgery, avoiding inguinodynia, and minimizing cognitive dysfunction. For anesthesiologists, the most important outcomes were returning to normal by 2 months, avoiding cognitive dysfunction, and preventing intraoperative pain. Hospital leaders agreed that normalization within 2 months and avoiding cognitive dysfunction were important, but they also considered readmission a critical outcome.

Surgery is only efficacious, cost effective, and ethical when it delivers outcomes that are important to patients. Discordance among patients, providers, and health systems can lead to miscommunication, ineffective or wasteful care, and poor outcomes.