Should we perform elective inguinal hernia repair in the elderly?

Wu, Jia-Rung; Baldwin, Blair; Goldwater, Eva; Counihan, Timothy C.

doi:10.1007/s10029-016-1517-3

Cited by 30 publications

(14 citation statements)

References 28 publications

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“…In addition, emergency surgery was associated with longer hospitalization. Our results concur with several studies that showed that emergency surgery carries higher morbidity and mortality rates, especially in older adults [8,15,16].…”

Section: Discussionsupporting

confidence: 93%

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Akeel¹

2021

Cureus

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Although inguinal hernia (IH) repair is low-risk surgery, older patients are occasionally offered watchful waiting because of their functional status and comorbidities. This study reviewed the surgical outcomes of IH repair in older patients in comparison with outcomes in younger patients. MethodsThis retrospective study included all patients who had IH repair from 2010 to 2020. The primary outcomes of interest were postoperative complications and recurrence. ResultsA total of 262 patients underwent IH repair during the study period; 40% were ≥60 years old. One patient had a recurrence. Among the 8% of patients who had postoperative complications, groin pain was the most common one (1.9%). Female patients had a significantly higher rate of complications than male patients did (38.5% female versus 6.4% male, p<0.001). The rate of complications was also higher for emergency surgery than for elective surgery (22.6% emergency versus 6.1% elective, p<0.001), as well for patients who needed concomitant bowel resection compared with those who did not. Patients who had emergency surgery or postoperative complications had a prolonged hospital stay. ConclusionsIH repair in older patients is low-risk surgery, comparable to that in younger patients. In this study, emergency surgery was more common in older than in younger patients and posed a higher risk of complications. We recommend offering elective hernia repair to older patients to avoid the higher complication rate associated with emergency repair.

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Section: Discussionsupporting

confidence: 93%

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Akeel¹

2021

Cureus

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“…El contexto que origina su complicación, incarceración o estrangulación es grave, ya que nos obligaría a recurrir a una cirugía urgente en la que tendríamos que enfrentarnos a una resección intestinal o a una peritonitis aguda que aumentaría la mortalidad de forma exponencial, puesto que el paciente es portador de comorbilidades complejas (cardiopatías, neumopatías, coagulopatías, etc.). Esto justifica adelantar la realización de los estudios preoperatorios para agilizar la cirugía de forma electiva, lo que evita el alto riesgo operatorio que supondría para estos pacientes una intervención urgente 12,21,22 .…”

Section: Discussionunclassified

PPP technique (plane polypropylene prosthesis): quick and safe procedure to repair recurrent inguinal hernia in high-risk patients

Martí¹,

Chornet²,

Lloret³

et al. 2021

Rev Hispanoam Hernia

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“…The safety of outpatient procedures was studied in a case mix group of 57,709 patients; the main reasons for readmission were hematoma, infection, and thromboembolic events (19). Gastroenterology and gynecology are the surgical specialties with the highest risk for return-hospital visits, and female sex is also a risk factor, whereas age is not (5). Another study of outpatient surgery demonstrated that pain and infection were the most common reasons for return-hospital visits, followed by fatigue and PONV, and the most common reasons for readmission were bleeding and infection (18).…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that watchful waiting may be safe, whereas it has also been stated that the improvement of quality of life in elderly patients with minimally symptomatic inguinal hernia represents an indication for elective herniorrhapy (1)(2)(3). It has been shown that elective inguinal hernia repair carries a mortality rate in the elderly patients similar to that in the general population (4,5). In addition, emergency inguinal hernia surgery is associated with remarkably higher morbidity and mortality rates than elective repairs (6,7).…”

Section: Introductionmentioning

confidence: 99%

Nursing Homes Nurses Attitudes Toward Older People and Affecting Factors

Söylemez¹

2018

tjgeri

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Materials and Method:A retrospective medical record review of geriatric patients aged ≥65 years (Group G, n=185) who had undergone outpatient inguinal hernia repair under local infiltration anesthesia (LIA) and sedation was conducted. Their data were compared with those of a group of nongeriatric patients aged 18-64 years (Group C, n=185). Patient selection, anesthetic and surgical care, and discharge criteria were protocol-based. Safety was evaluated in terms of incidence of adverse events, discharge delay, unanticipated admission and readmission and time to discharge.Results: Results for the Groups G and C were age 73. mg, respectively. Times to discharge were 102±19 min and 91.2±22.5 min in Groups G and C, respectively. Groups were similar regarding the rate of intraoperative and postoperative adverse events, except for ecchymosis (n=2 in Group G vs. n=10 in Group C) and the rates of discharge delay, unanticipated admission, and readmission.Conclusion: Outpatient inguinal herniorrhaphy under LIA and sedation in geriatric patients is as safe as in the nongeriatric patients, provided that protocol-based preoperative evaluation and discharge criteria and appropriate anesthetic management and surgical techniques are followed.Keywords: Geriatrics; Outpatient; General Surgery; Herniorrhaphy Giriş: Geriatrik hastalarda günübirlik kasık fıtığı onarımının güvenliğinin araştırılması amaçlanmıştır.Gereç ve Yöntem:Lokal anestezi ve sedasyon altında günübirlik kasık fıtığı onarımı yapılan yaşları ≥65 yıl (Grup G, n=185) olan hasta kayıtları geriye dönük olarak incelendi ve veriler, yaşları 18-64 yıl (Grup K, n=185) olan hastaların verileri ile karşılaştırıldı. Hasta seçimi, anestezi ve cerrahi bakım ve taburculuk belirli protokollere göre yapıldı. Sonuç ölçütleri, istenmeyen olayların görülme sıklığı, taburculuk süresi, taburculuk geçikmesi ve planlanmamış hastane yatışı ile yeniden hastaneye başvuru sıklığıdır. Sonuç: Geriatrik hasta grubunda, lokal anestezi ve sedasyon altında yapılan günübirlik kasık fıtığı onarımı, protokol bazlı preoperatif değerlendirme ve taburculuk kuralları ve uygun anestezik ve cerrahi bakım uygulanmak koşulu ile genç hastalardaki kadar güvenlidir.

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Should we perform elective inguinal hernia repair in the elderly?

Abstract: 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.

Cited by 30 publications

References 28 publications

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

PPP technique (plane polypropylene prosthesis): quick and safe procedure to repair recurrent inguinal hernia in high-risk patients

Nursing Homes Nurses Attitudes Toward Older People and Affecting Factors

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