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Should we perform elective inguinal hernia repair in the elderly?
*Blair C Baldwin1, Timothy Counihan1, *Eva Goldwater2, Jacqueline Wu1
1Berkshire Medical Center, Pittsfield, MA;2University of Massachusetts, Amherst, MA

Objective
Many surgeons are reluctant to offer elective inguinal and femoral hernia repair (IHR) to the elderly due to concerns of increased risk. The authors sought to evaluate the outcomes of elderly patients undergoing IHR compared to the general population.
Design
Retrospective review
Setting
IHRs in the 2011 NSQIP database
Patients
19,683 patients undergoing IHR.
Interventions
Patients were divided by age into three categories: <65, 65-79 and >80. Logistic regression analysis was used to assess impact of comorbid conditions and type of surgery on outcomes.
Main Outcome Measures
Patients were analyzed for mortality and complications based on their age and the types of surgery (elective, urgent, emergent, laparoscopic vs. open) and comorbid conditions.
Results
There were 17,375 male patients (88%). 92.7% were elective. 70% were performed using an open technique. Age distribution was 63.4% < 65, 26.6% 65-79, 10% > 80. Morbidity and mortality data is in table 1. Mortality was similar between laparoscopic and open in <65 (OR=0.96, p=0.97) and unable to be assessed in other age groups. Dyspnea and COPD predicted higher mortality and complications with emergency surgery in the elderly (age 65-79 OR 15.3 and 14.9 respectively, age >80 OR 56.5 and 14.9 respectively.)
Conclusions
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.
Mortality and morbidity by age, emergent and elective,all P values <0.001
OutcomeAgeAgeAge
<65-65-79->80-
%Odds Ratio%Odds Ratio%Odds Ratio
Any complicationElective0.7-1.1-1.0-
Emergent4.25.910.99.815.817.6
MortalityElective.0-0.2-0.2-
Emergent0.614.33.617.510.357
Ventilator >48hrsElective0.0-0.1-0.3-
Emergent0.927.73.130.14.015.8
ReadmissionElective1.5-3.0-4.6-
Emergent4.32.78.33.012.63.3
Return to ORElective0.4-1.0-1.0-
Emergent2.86.93.63.94.74.7


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