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Effects of cognitive status on outcomes of groin hernia repair using various anesthesia techniques

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Abstract

Background and Aim

Because of increasing life expectancy, there is an increasing number of cognitively impaired older individuals undergoing surgeries such as groin hernia repair. Here, we evaluated the effects of cognitive status on postoperative complication rates in patients undergoing groin hernia repair using various anesthesia techniques. We also analyzed the rate of same-day hernia surgery in patients with cognitive decline.

Methods

Patients who presented to our general surgery clinic for unilateral or bilateral inguinal or femoral hernia were prospectively classified into general (group 1), local (group 2), and spinal (group 3) anesthesia groups. The Mini-Mental State Examination (MMSE) was used for preoperative evaluation of each patient’s cognitive status. The Visual Analog Scale (VAS) was used to evaluate postoperative pain. Groups were compared in terms of age, MMSE and VAS scores, cognitive decline and complication rates, and surgery duration.

Results

In total, 33 (35.1%), 30 (31.9%), and 31 (33.0%) of 94 patients underwent surgery using general, local, and spinal anesthesia, respectively. The mean MMSE score did not differ among groups (p = 0.518). Cognitive decline was present in 18 (19.2%) patients, and the proportion did not significantly differ among groups. The complication rate did not differ between patients with and without cognitive decline. The mean surgery duration was similar among the three groups (p = 0.127). Group 2 had a lower mean postoperative VAS score, compared with the other groups (p < 0.001). Complications because of anesthesia and surgery were significantly more common in group 3 than in the other groups (p = 0.025). In the local anesthesia group, 7 patients had cognitive decline and 22 patients had normal cognition. There were no significant differences between patients with and without cognitive decline in terms of mean surgery duration (50.3 ± 15.4 min vs. 45.2 ± 10.7 min; p = 0.338) or mean VAS score (3.14 ± 0.90 vs. 3.13 ± 0.77; p = 0.985). Among the 22 and 7 patients without and with cognitive decline, 11 (50%) and 0 patients were discharged on the same day (p = 0.025). In the local anesthesia group, the respective median ages were 70, 52, and 59 years for patients with cognitive decline, patients with normal cognition discharged on the same day, and patients with normal cognition who were not discharged on the same day (p = 0.001).

Conclusion

Groin hernia repair was successfully performed under local anesthesia in all patients, including older patients with cognitive decline. Patients with cognitive decline were not discharged on the day of surgery, although the mean surgery duration and postoperative VAS score did not differ between patients with and without cognitive decline. Prolonged hospitalization in patients with cognitive decline may be related to their advanced age. Further studies are needed to determine the safety of same-day surgery in patients with cognitive decline.

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Data availability

Data is available upon reasonable request.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. The study was approved by the Sakarya University ethics committee (approval no.: E- 16214662–050.01.04–125,288-52).

Informed consent

Informed consent was obtained from the patients.

Human and animal rights

No animals were used for this study.

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Authors and Affiliations

  1. Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey

    Recayi Capoglu, Emre Gonullu & Hakan Demir

  2. Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey

    Murat Alemdar & Emre Gonullu

  3. Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey

    Zulfu Bayhan, Emre Gonullu, Emrah Akın, Fatih Altintoprak, Ahmet Tarik Harmantepe, Furkan Kucuk & Bahaeddin Umur Aka

  4. Department of Gastrointestinal Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey

    Emre Gonullu

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  1. Recayi Capoglu
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Capoglu, R., Alemdar, M., Bayhan, Z. et al. Effects of cognitive status on outcomes of groin hernia repair using various anesthesia techniques. Hernia 27, 1315–1323 (2023). https://doi.org/10.1007/s10029-022-02725-4

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