Abstract
PurposeThe incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed.MethodsThis is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed.Results259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortalityConclusionEmergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation
Highlights
Inguinal and femoral hernias are very common clinical situations worldwide with estimated prevalence of 27–43% in men and 3–6% in women [1]
The present study shows that emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients
Femoral hernia was associated with a higher risk of laparotomy and bowel resection
Summary
Inguinal and femoral hernias are very common clinical situations worldwide with estimated prevalence of 27–43% in men and 3–6% in women [1]. Regardless of age and frailty European Hernia Society Guidelines recommend surgery in case of symptomatic inguinal hernia; whereas if patients do not complain of symptoms the indication to surgical repair is debated, being a watchful approach an option [3]. The natural history of a conservatively managed groin hernia is size increasing due to continuous action of intra-abdominal pressure and progressive abdominal wall laxity [3]. This exposes patients to an increasing risk of bowel obstruction and strangulation requiring emergency surgery with consequent risk of laparotomy and bowel resection [7]. The balance between the risks of elective surgery versus the risks of a watchful approach is still a matter of debate in absence of specific recommendations for elderly
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