Should we perform elective inguinal hernia repair in the elderly?

Abstract

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. We performed a retrospective review of the 2011 NSQIP database evaluating 19,683 patients undergoing IHR. 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. Patients were analyzed for mortality and complications based on their age and the types of surgery (elective, urgent, emergent, laparoscopic versus open) and comorbid conditions. 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. Mortality was similar across age groups in elective repair. Mortality was increased in emergency repair in all age groups (p<0.001). Mortality was increased in emergency surgery compared to elective surgery in patients>80 (OR=57, p<0.001). 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). 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.