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Should we perform elective inguinal hernia repair in the elderly?

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A Comment to this article was published on 20 April 2017

A Comment to this article was published on 18 January 2017

Abstract

Purpose

Many surgeons are reluctant to offer elective inguinal and femoral hernia repair (IHR) to the elderly due to concerns of increased risk. The authors sought to evaluate the outcomes of elderly patients undergoing IHR compared to the general population.

Methods

We performed a retrospective review of the 2011 NSQIP database evaluating 19,683 patients undergoing IHR. Patients were divided by age into three categories: <65, 65–79 and >80. Logistic regression analysis was used to assess impact of comorbid conditions and type of surgery on outcomes. Patients were analyzed for mortality and complications based on their age and the types of surgery (elective, urgent, emergent, laparoscopic versus open) and comorbid conditions.

Results

There were 17,375 male patients (88 %). 92.7 % were elective. 70 % were performed using an open technique. Age distribution was 63.4 % < 65, 26.6 % 65–79, 10 % >80. Mortality was similar across age groups in elective repair. Mortality was increased in emergency repair in all age groups (p < 0.001). Mortality was increased in emergency surgery compared to elective surgery in patients >80 (OR = 57, p < 0.001). Mortality was similar between laparoscopic and open in <65 (OR = 0.96, p = 0.97) and unable to be assessed in other age groups. Dyspnea and COPD predicted higher mortality and complications with emergency surgery in the elderly (age 65–79 OR 15.3 and 14.9, respectively, age >80 OR 56.5 and 14.9, respectively).

Conclusions

Elective inguinal hernia repair carries a similar mortality in the elderly compared to the general population. Emergent IHR carries a very high risk of death in the elderly. The authors recommend considering elective IHR regardless of age.

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Authors and Affiliations

  1. Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA

    J. J. Wu

  2. Berkshire Medical Center, 725 North Street, Pittsfield, MA, 01201, USA

    B. C. Baldwin

  3. University of Massachusetts Amherst, Amherst, MA, USA

    E. Goldwater

  4. Veteran Affairs Medical Center, White River Junction, VT, USA

    T. C. Counihan

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  1. J. J. Wu
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  2. B. C. Baldwin
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  3. E. Goldwater
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  4. T. C. Counihan
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Correspondence to J. J. Wu.

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Conflict of interest

JW declares no conflict of interest. BB declares no conflict of interest. EG declares no conflict of interest. TC declares no conflict of interest.

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Wu, J.J., Baldwin, B.C., Goldwater, E. et al. Should we perform elective inguinal hernia repair in the elderly?. Hernia 21, 51–57 (2017). https://doi.org/10.1007/s10029-016-1517-3

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  • DOI: https://doi.org/10.1007/s10029-016-1517-3

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