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Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians

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Abstract

Background

The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80–89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality.

Study design

Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (2007–2008). Univariate analysis was performed using chi square, Fisher’s exact test and t test. Multivariate logistic regression analysis was carried out to assess factors associated with increased postoperative complications and mortality.

Results

Of 2,377 patients above 80 years of age, 226 (9.5 %) were nonagenarians. Men accounted for 81.4 % (1,936) of patients. There were significantly more female patients in the nonagenarian group (29.2 vs. 17.4 %, p < 0.0001). Laparoscopic repair was performed in 210 (9.9 %) patients. Emergency repair was more frequent in nonagenarians than octogenarians (12 vs. 4.4 %, p < 0.0001). The 30-day overall complication rate was significantly increased in nonagenarians compared to octogenarians (6.1 vs. 3.2 %, p = 0.03). Mortality is increased tenfold in elective inguinal hernia repair in nonagenarians compared to octogenarians (3 vs. 0.3 %, p < 0.0005). On multivariate analysis, preoperative variables found to be significantly associated with morbidity included totally dependent functional status, congestive heart failure and emergent nature of procedure, while higher age, emergency repair and open wound are associated with increased mortality.

Conclusions

Elective inguinal hernia repair can be safely performed in octogenarians with low morbidity and mortality but is increased in nonagenarians. More vigilant postoperative care is required after emergent hernia repairs due to the increased risk of morbidity and mortality, and effort should be made to electively repair inguinal hernias early in this elderly population.

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Conflict of interest

None.

Disclaimer

The ACS NSQIP and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. This study does not represent the views or plans of the ACS or the ACS NSQIP.

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Authors and Affiliations

  1. Department of Surgery, Creighton University, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA

    P. K. Pallati, P. K. Gupta & R. A. Forse

  2. Department of Medicine, Creighton University, Omaha, NE, 68131, USA

    S. Bichala & H. Gupta

  3. Biostatistical Core, Creighton University, Omaha, NE, 68131, USA

    X. Fang

Authors
  1. P. K. Pallati
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  2. P. K. Gupta
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  3. S. Bichala
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  4. H. Gupta
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  5. X. Fang
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  6. R. A. Forse
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Correspondence to P. K. Pallati.

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Pallati, P.K., Gupta, P.K., Bichala, S. et al. Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians. Hernia 17, 723–727 (2013). https://doi.org/10.1007/s10029-012-1040-0

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  • DOI: https://doi.org/10.1007/s10029-012-1040-0

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