Skip to main content
SpringerLink
Log in

Ventral hernia repairs in the oldest-old: high-risk regardless of approach

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Ventral hernia repairs (VHR) are among the most common procedures performed by general surgeons. Even though the US population is aging, outcomes of VHR in the elderly and oldest-old (≥80 years) are not well documented. Our study aims to evaluate the short-term outcomes of VHR in the oldest-old patients.

Methods

The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent VHR based on Current Procedural Terminology codes between 2005 and 2011. Chi square, Fisher’s exact and two-tailed Student’s t test were used to compare baseline characteristics and outcomes. Binary logistic regression was used to control for confounding variables. Odds ratios (OR) with 95 % confidence intervals (CI) were reported when applicable.

Results

We identified 123,151 patients who underwent a VHR; 4,917 (4 %) were ≥80 years of age. The incidence of laparoscopy increased from 19.8 % in 2009–23.2 % in 2011 (p < 0.001). 30-day unadjusted mortality was 1.7 versus 0.1 % for younger patients (p < 0.001). After controlling for baseline differences, age ≥80 years was an independent predictor of overall morbidity (OR 1.4, 95 % CI 1.3–1.6, p < 0.001), serious morbidity (OR 1.6, 95 % CI 1.4–1.8, p < 0.001) and mortality (OR 3.5, 95 % CI 2.5–4.6, p < 0.001). Oldest-old patients undergoing laparoscopic VHR had a lower incidence of surgical site infection (SSI) compared with patients with open repair (1 vs. 3.4 %, p = 0.001). Mortality, serious morbidity and overall morbidity were not significantly different.

Conclusions

VHR in the oldest-old carried significantly higher 30-day overall morbidity, serious morbidity and mortality, compared with younger patients. The use of laparoscopy was associated with improved SSI. Mortality and morbidity were associated with emergency surgery, wound classification and baseline comorbidities, but not surgical approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. King J, Fraher EP, Ricketts TC, Charles A, Sheldon GF, Meyer AA (2009) Characteristics of practice among rural and urban general surgeons in North Carolina. Ann Surg 249:1052–1060

    Article  PubMed  Google Scholar 

  2. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183

    Article  CAS  PubMed  Google Scholar 

  3. Israelsson LA, Jonsson T (1993) Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 80:1284–1286

    Article  CAS  PubMed  Google Scholar 

  4. Millbourn D, Cengiz Y, Israelsson LA (2009) Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 144:1056–1059

    Article  PubMed  Google Scholar 

  5. Werner CA (2011) US Census Bureau. Census briefs, C2010BR-09. The older population: 2010. http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf. Accessed 25 Mar 2013

  6. He W, Sengupta M, Velkoff VA, DeBarros KA (2005) US Census Bureau. Current population reports, P23-209. 65+ in the United States: 2005. https://www.census.gov/prod/2006pubs/p23-209.pdf. Accessed 26 Mar 2013

  7. Colavita PD, Tsirline VB, Belyansky I, Walters AL, Lincourt AE, Sing RF, Heniford BT (2013) Laparoscopic versus open hernia repair: outcomes and socio demographic utilization results from the nationwide inpatient sample. Surg Endosc 27:109–117

    Article  PubMed  Google Scholar 

  8. Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D, Neumayer L, Ventral Incisional Hernia Investigators (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145:322–328

    Article  PubMed  Google Scholar 

  9. Mason RJ, Moazzez A, Sohn HJ, Berne TV, Katkhouda N (2011) Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database. Ann Surg 254:641–652

    Article  PubMed  Google Scholar 

  10. Blount AL, Craft RO, Harold KL (2009) Safety of laparoscopic ventral hernia repair in octogenarians. JSLS 13:323–326

    PubMed  PubMed Central  Google Scholar 

  11. Polavarapu HV, Kurian AA, Josloff R (2012) Laparoscopic ventral hernia repair in the elderly: does the type of hernia matter? Hernia 16:425–429

    Article  CAS  PubMed  Google Scholar 

  12. Lee YK, Iqbal A, Vitamvas M, McBride C, Thompson J, Oleynikov D (2008) Is it safe to perform laparoscopic ventral hernia repair with mesh in elderly patients? Hernia 12:239–242

    Article  CAS  PubMed  Google Scholar 

  13. Hamel MB, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53:424–429

    Article  PubMed  Google Scholar 

  14. Belyaev O, Herzog T, Kaya G, Chromik AM, Meurer K, Uhl W, Muller CA (2013) Pancreatic surgery in the very old: face to face with a challenge of the near future. World J Surg 37:1013–1020

    Article  PubMed  Google Scholar 

  15. Tapias LF, Muniappan A, Wright CD, Gaissert HA, Wain JC, Morse CR, Donahue DM, Mathisen DJ, Lanuti M (2013) Short and long-term outcomes after esophagectomy for cancer in elderly patients. Ann Thorac Surg 95:1741–1748

    Article  PubMed  Google Scholar 

  16. Hwang CS, Wichterman KA, Alfrey EJ (2009) Laparoscopic ventral hernia repair is safer than open repair: analysis of the NSQIP data. J Surg Res 156:213–216

    Article  PubMed  Google Scholar 

  17. Reynolds D, Davenport D, Roth JS (2013) Predictors of poor outcomes in functionally dependent patients undergoing ventral hernia repair. Surg Endosc 27:1099–1104

    Article  PubMed  Google Scholar 

  18. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781. doi: 10.1002/14651858

  19. Dunne JR, Malone DL, Tracy JK, Napolitano LM (2003) Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res 111:78–84

    Article  PubMed  Google Scholar 

  20. Baskett RJ, MacDougall CE, Ross DB (1999) Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg 67:462–465

    Article  CAS  PubMed  Google Scholar 

  21. Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP, Finerty EA, Nguyen JT, Gausden E, Sama AA (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am 93:1627–1633

    Article  PubMed  Google Scholar 

  22. Greenblatt DY, Rajamanickam V, Mell MW (2011) Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg 54:433–439

    Article  PubMed  Google Scholar 

  23. Surgical Care and Outcomes Assessment Program Collaborative, Kwon S, Billingham R, Farrokhi E, Florence M, Herzig D, Horvath K, Rogers T, Steele S, Symons R, Thirlby R, Whiteford M, Flum DR (2012) Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg 214:909–918

    Article  PubMed  PubMed Central  Google Scholar 

  24. Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

No external funding was obtained or used for the purposes of this study.

Disclosures

The authors have no financial ties or conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA

    Konstantinos Spaniolas

  2. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Thadeus L. Trus & Gina L. Adrales

Authors
  1. Konstantinos Spaniolas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thadeus L. Trus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gina L. Adrales
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Konstantinos Spaniolas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spaniolas, K., Trus, T.L. & Adrales, G.L. Ventral hernia repairs in the oldest-old: high-risk regardless of approach. Surg Endosc 28, 1230–1237 (2014). https://doi.org/10.1007/s00464-013-3313-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3313-9

Keywords

Search

Navigation