Frailty in a low-risk elective setting: a quality improvement study at Shouldice Hospital

Area of Science:

• Hernia Surgery Outcomes
• Geriatric Surgery
• Quality Improvement in Surgery

Background:

• Frailty is increasingly recognized as a significant factor influencing surgical outcomes.
• The Shouldice primary inguinal hernia repair (SPIHR) is a standardized procedure often performed electively.
• Evaluating frailty's impact is crucial for quality control in SPIHR.

Purpose of the Study:

• To assess the influence of frailty on postoperative outcomes following Shouldice primary inguinal hernia repair (SPIHR).
• To determine if frailty status affects complication rates in a standardized elective surgical setting.

Main Methods:

• A quality improvement study analyzed prospective data from a patient-reported outcome measure (PROM) program.
• Frailty was assessed using the 5-item modified Frailty Index (mFI-5).
• Postoperative complications were identified via questionnaires and clinical verification, with outcomes compared between frail and non-frail groups using statistical analyses.

Main Results:

• 1,300 patients undergoing SPIHR were analyzed; 29.7% were classified as frail (mFI-5 ≥ 1).
• Frail patients were older, had higher BMI, greater comorbidity burden, and larger hernias.
• No significant difference in postoperative complication rates was observed between frail and non-frail patients.

Conclusions:

• Frailty is prevalent in nearly one-third of patients undergoing SPIHR.
• Short-term postoperative complication rates are comparable between frail and non-frail individuals.
• Primary Shouldice repair appears feasible and safe for frail patients in a standardized elective setting.