A study to analyze the safety and feasibility of inguinal hernia repair in day surgery mode in elderly patients over 70 years old ： A propensity score- matched study

Abstract

Introduction: Inguinal hernia repair is becoming increasingly popular as a day surgery as the proportion of elderly people increases, Relevant studies have not been completed; therefore, our objective was to evaluate the safety and feasibility of day surgery modalities for inguinal hernia repair in elderly patients aged 70 years and older. Methods: Clinical data of patients who underwent inguinal hernia repair in the Department of Gastrointestinal Hernia Surgery of Nanchong Central Hospital from January 2020 to December 2023 were retrospectively collected. The patients were divided into three groups, ≥70 years old day surgery group, ≥70 years old inpatient surgery group and <70 years old day surgery group, according to the mode of admission and age, and the propensity score matching method was used to match the ≥70 years old day surgery group with the ≥70 years old inpatient surgery group, and the ≥70 years old daysurgerysurgery group with the <70 years old day surgery group, respectively, in a two-by-two study. The clinical indicators of postoperative recovery period between the two groups were compared after matching, respectively. Results: In this study, 230 patients ≥70 years old who underwent day surgery, 645 patients ≥70 years old who underwent inpatient surgery, and 570 patients <70 years old who underwent day surgery were included in this study. 230 patients were included in each of the two groups of ≥70 years old day surgery group and ≥70 years old inpatient surgery group as a comparative study after 1:1 propensity-matched study, and both groups were compared with each other in terms of Intraoperative bleeding, operative time, postoperative fever, vomiting, and urinary retention, VTE, seroma, incision healing, discharge VAS pain score, and recurrence were compared without significant differences (P>0.05). However, the two groups of patients were compared in terms of hospitalization cost (≥70 years old day surgery group (12990.42±3399.614 CNY), ≥70 years old inpatient surgery group (15006.84±3045.871 CNY), P<0.001) the cost of the inpatient surgery group was higher than the cost of the day surgery group, and the difference was statistically significant. Also after a 1:1 propensity matching study, 155 patients were included in each of the two groups of ≥70 years old day surgery group and <70 years old day surgery group as a comparative study, and it was found that there was no significant difference in the comparison between the two groups in terms of Intraoperative bleeding, operative time, inpatient costs, postoperative fever, vomiting, urinary retention, VTE, seromas, incision healing, discharge VAS pain, and recurrence (P>0.05). Conclusion: A retrospective study based on PSM matching has shown that it is safe and feasible to perform daytime hernia surgery in elderly patients over 70 years of age who are well assessed for anesthetic risk and who have underlying medical conditions that do not require complex multidisciplinary care.