Outcomes Of Inguinal Hernia Repair Research Articles

Comparison of outcome of inguinal hernia repair by combined method of repair (Lichtenstein and Bassini repair) and its comparison with older techniques

Background: The aim of this study is to compare outcome of inguinal hernia repair by combined method of repair (Lichtenstein and Bassini repair) and its comparison with older techniques.Methods: A prospective study conducted on 158 patients reported in surgery OPD Patna Medical College and Hospital, Patna from July 2017 to June 2018 with inguinal hernia. All these patients were included in the study, operated by combined method of repair (Lichtenstein and Bassini repair) and followed up for 12 months. Data were entered and analyzed by SPSS version 10.0.Results: Study involved 158 patients who were operated by combined repair. Pain on 1st post-operative day was similar with previous study. Complication was erythema, scrotal swelling, neuralgia, superficial wound infection and seroma formation in the order of frequency. The average hospital stay was 5 days for combined approach. Recurrence rate was 0% in combined approach following 1 year of follow-up.Conclusions: As compared with previous studies of hernia repair by Modified Bassini’s and Lichenstein mesh hernioplasty, combined approach have comparatively better outcome.

Comparing routine administrative data with registry data for assessing quality of hospital care in patients with inguinal hernia.

Collecting clinical data is viewed as the gold standard for assessing health-care quality. However, considerable investment is needed if the quality of care is to be recorded over a long period of time. Accordingly, the question arises as to whether routine administrative data may be used for quality assurance purposes if certain methodological standards are followed. This present study now compares the outcomes of inguinal hernia repair from the Herniamed Hernia Registry with routine data from Germany's largest sickness fund, the Local General Sickness Fund "AOK". Included in the study were the hospital inpatient cases for the years 2011-2013 with inguinal hernia surgical repair whose data had been prospectively entered into the voluntary Herniamed Hernia Registry by 318 participating hospitals. These collectives were then compared, on the basis of the routine administrative data available, with patients from the AOK sickness fund who had been operated on during the same time period. The outcome criteria selected were the perioperative complication rates within 30days as well as the recurrence rate and the pain rate requiring treatment at 1-year follow-up. The data records examined comprised 64,748 cases from the Herniamed Registry and 130,121 AOK cases. Since in the Herniamed collective, the proportion of bilateral procedures was significantly higher, only the collectives of elective primary unilateral inguinal hernias in men (Herniamed n = 37,667; AOK n = 78,973) were compared. The most pronounced difference between these two collectives was in the proportion of laparo-endoscopic procedures (Herniamed 61.3% vs AOK 49.0%; p < 0.001). Accordingly, the Herniamed collective was found to have a significantly lower postoperative surgical complication rate (Herniamed 1.5% vs AOK 2.6%; p < 0.001) and surgical site infection (SSI) rate (Herniamed 0.3% vs AOK 0.6%; p < 0.001) within 30days after the operation. On the other hand, the pain rates requiring treatment in the Herniamed collective were somewhat higher (Herniamed 3.0% vs AOK 2.6%; p < 0.001). No difference was found in the recurrence rate at 1-year follow-up (Herniamed 1.0% vs AOK 0.9%; ns). Subject to critical evaluation of the limitations of data acquisition in this study, it does appear possible to use the routine administrative data from the AOK Sickness Fund for assessment of the quality of inguinal hernia surgery in Germany. Voluntary participation in the Herniamed Registry appears to be characterized by the fact that the participating hospitals conduct a higher proportion of laparo-endoscopic inguinal hernia repair. That could possibly explain the differences in outcome. However, in large patient collectives, statistical significance should not always be equated with clinical relevance. Univariate analysis does not take account of differences in the hernia findings, risk factors or operative details. Further efforts should be employed in future to improve the accuracy and granularity of routine administrative data for assessing the quality of care and to decrease the cost of gathering such data.

State of the art: open mesh-based inguinal hernia repair.

Open inguinal hernia repair remains the most universal, ubiquitous, reliable, and cost-effective method of addressing the global burden of groin hernias. Advances in anatomic understanding and technique have refined a few well-established techniques that can address the majority of the burden of disease with low rates of morbidity, recurrence, and chronic pain. Prosthetic reinforcement has become routine because of the clear reduction in recurrence rates in general practice conferred by mesh and the less-appreciated consideration of simplification of the repair whereby operator variability, hernia type, anatomic variation, patient habitus, tissue deficiencies, and surgical technique are homogenized by reproducible standard techniques. While minimally invasive laparoscopic and robotic approaches have increased in popularity, availability, and reliability, open inguinal-repair techniques continue to provide durability, low risk, minimal cost, ease of training and dissemination, and excellent outcomes and remain a fundamental foundation for the practice and art of hernia surgery. Additionally, as chronic pain and quality of life metrics supersede recurrence as the primary clinical outcome of inguinal hernia repair, the ability to offer a "tailored approach" with several options ranging from tissue- and mesh-based open repairs to minimally invasive prosthetic reinforcement has become an important consideration in providing each patient with different options and the best possibility of a favorable outcome. Paramount to this is a solid understanding of the anatomy and standardization of proper technique for each operation to minimize complications and maximize patient outcomes.

Pure tissue inguinal hernia repair with the use of biological mesh: a 10-year follows up. A prospective study.

The long-term results for inguinal hernia repair (IH) with the use of biological mesh (BM) are not known. A prospective study was started in 2003-2004 to evaluate the results of pure tissue (IH) repair with the use of biological mesh with a 10-year follow-up. From March 2003 to December 2004, all patients with IH who presented to the office, including incarcerated and recurrent IH, not excluding any, underwent pure tissue IH repair reinforced with a BM. During this period, 101 patients (87/male, 14/female) underwent 104 IH repair with a continuous suture of transversalis to transversalis fascia repair reinforced with BM of porcine intestinal submucosal origin (Surgisis, Cook) and were followed up for 10 years. There were 104 IH, 90 electives (86%), 2 incarcerated (1.9%), and 12 recurrent (11%). Follow-up was scheduled at 1 week, 1 month, 1 year, 3 years, 7 years and 10 years., in 100%, 100%, 99%, 93%, 89% and 85% of the patients, respectively. Recurrence was observed in 2/104 (1.9%): one recurrence at 1 week in a patient with bilateral IH and one at 7 years. The mean recovery time was 1.2 days (range 1-5 days). Mortality was 0(0%). six hematic infiltration to the scrotum and one to the vulva, all resolved spontaneously; wound infection 0(0%); urinary retention 11/104 (10.5%); inguinal scrotal hypoesthesia 7/104(6.7%), improved after 4-6months; asymptomatic fever of 39°C, 2/104 patients (1.9%), responded to a single dose of 4 mg betamethasone. No long-term inguinal pain complaint was found except for one patient with a recurrent IH. The use of BM to reinforce a pure tissue IH repair is safe and effective. The recurrence rate is comparable to short- and long-term synthetic mesh IH repair with less complications and pain than the use of synthetic mesh as reported in the literature.

Variation in outcomes and use of laparoscopy in elective inguinal hernia repair.

BackgroundThe early outcomes of inguinal hernia repair in routine practice and the extent to which the laparoscopic approach is used are unknown. The aims of this study were to identify national benchmarks for early reoperation and readmission rates, to identify the degree to which the laparoscopic approach is used for elective hernia surgery in England, and to identify whether there is any variation nationally.MethodsAll adults who underwent publically funded elective inguinal hernia repair in England during the six financial years from 2011–2012 to 2016–2017 were identified in the Surgeon's Workload Outcomes and Research Database (SWORD). Patients were grouped according to whether they had a primary, recurrent or bilateral hernia, and according to sex. Overall rates of readmission, reoperation and laparoscopic approach were calculated, and variation was assessed using funnel plots.ResultsSome 390 777 patients were included. Overall, 11 448 patients (2·9 per cent) were readmitted to hospital as an emergency within 30 days of surgery and 2872 (0·7 per cent) had a further operation. Laparoscopic repair was performed for 65·5 per cent of bilateral inguinal hernias compared with 17·1 per cent of primary unilateral inguinal hernias, 31·3 per cent of recurrent hernia repairs and 14·0 per cent of primary unilateral hernias in women. The unadjusted readmission, reoperation and laparoscopy rates varied significantly between hospitals.ConclusionThe likelihood of a patient being readmitted to hospital, having an emergency reoperation or undergoing laparoscopic inguinal hernia repair varies significantly depending on the hospital to which they are referred. Hospitals and service commissioners should use this data to drive service improvement and reduce this variation.

The Impact of Groin Surgery during Childhood on the Incidence of Inguinal Hernia Repair and Its Postoperative Complications in Adult Life.

Pediatric inguinal hernia, hydrocele, and cryptorchidism are common congenital anomalies affecting children, and require surgical intervention in some cases. The association between surgical treatment of these conditions and acquired inguinal hernia later in life is poorly understood. The aim of this cohort study was to examine the effect of groin surgery during childhood on the incidence and surgical outcome of inguinal hernia repair in adult life. Data from the Swedish Inpatient Register and the Swedish Hernia Register were cross-linked using the patient personal identity numbers. The incidence of inguinal hernia repair in patients 15 years or older in the study cohort, as well as postoperative complication rates, were compared with the expected incidence and complication rates extrapolated from the general Swedish population in 2014, stratifying for age and gender. Note that 68,238 children aged 0 to 14 years were found to have undergone groin surgery between 1964 and 1998. The median follow-up time after an operation in the groin was 30.8 years (21.0-50.0). Of those, 1,118 were found to have undergone inguinal hernia repair as adults (> 15 years old) between 1992 and 2013. The incidence of inguinal hernia repair in the cohort was significantly higher than that expected (1.43 [1.33-1.53]), both for men (1.32 [1.25-1.41]) and women (4.30 [3.28-5.55]). The incidence was also increased in the subgroup of patients that had undergone more than one procedure during childhood. No significant impact on postoperative complication rate, reoperation rate, or operation time was identified. Individuals undergoing surgery in the groin during childhood are at increased risk for acquired inguinal hernia surgery later in life. Inguinal surgery during childhood did not affect the outcome of hernia repair in adult age.

Current Concepts of Inguinal Hernia Repair

With more than 20 million patients annually, inguinal hernia repair is one of the most often performed surgical procedures worldwide. The lifetime risk to develop an inguinal hernia is 27-43% for men and 3-6% for women. In spite of all advances, 11% of all patients suffer from a recurrence and 10-12% from chronic pain following primary inguinal hernia repair. By developing evidence-based guidelines and recommendations, the international hernia societies aim to improve the outcome of inguinal hernia repair due to standardization of care. From a total of more than 100 different repair techniques for inguinal and femoral hernias, classified as tissue repair, open mesh repair, and laparo-endoscopic mesh repair, the new International Guidelines of the Hernia-Surge Group only recommend the totally extraperitoneal patch plasty (TEP), transabdominal preperitoneal patch plasty (TAPP), and Lichtenstein techniques. Since a generally accepted technique suitable for all inguinal hernias does not exist, surgeons should provide both an anterior open (Lichtenstein) and a posterior laparo-endoscopic (TEP or TAPP) approach option. The guidelines strongly recommend that surgeons tailor the treatment of inguinal hernias based on expertise, local/national resources, and patient- and hernia-related factors. A tailored approach in inguinal hernia repair should pay heed to the patient- and hernia-related factors, unilateral hernia in men and women, bilateral hernia, recurrent hernia, scrotal hernia, previous pelvic and lower abdominal surgery, severe cardiac or pulmonary comorbidities, and incarcerated hernia.

Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair.

Background and Aims The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.

Results of Inguinal Hernia Repair By PIRS Method in Girls

Results of Inguinal Hernia Repair By PIRS Method in Girls

Explaining variation in ventral and inguinal hernia repair outcomes: A population-based analysis

No study has evaluated the relative importance of patient, surgeon, and hospital-level factors on surgeon and hospital variation in hernia reoperation rates. This population-based retrospective cohort study evaluated factors associated with variation in reoperation rates for recurrence after initial ventral hernia repair and inguinal hernia repair. The Statewide Planning and Research Cooperative System identified initial ventral hernia repairs and inguinal hernia repairs in New York state from 2003-2009. Mixed-effects Cox proportional hazards analyses were performed assessing factors associated with surgeon/hospital variation in 5-year reoperation rates for hernia recurrence. Among 78,267 ventral hernia repairs and 124,416 inguinal hernia repairs, the proportion of total variation in reoperation rates attributable to individual surgeons compared with hospitals was 87% for ventral hernia repairs and 92% for inguinal hernia repairs. In explaining variation in ventral hernia repair reoperation between surgeons, 19% was attributable to patient-level factors, 4% attributable to mesh placement, and 10% attributable to surgeon volume and type of board certification. In explaining variation in inguinal hernia repair reoperation between surgeons, 1.1% was attributable to mesh placement and 10% was attributable to surgeon volume and years of experience. However, 67% of the variation between surgeons for ventral hernia repair and 89% of the variation between surgeons for inguinal hernia repair remained unexplained by factors in the models. The majority of variation in hernia reoperation rates is attributable to surgeon-level variation. This suggests that hernia recurrence may be an appropriate surgeon quality metric. While modifiable factors such as mesh placement and surgeon characteristics play roles in surgeon variation, future research should focus on identifying additional surgeon attributes responsible for this variation.

Data and outcome of inguinal hernia repair in hernia registers – a review of the literature

Register-based observational studies in inguinal hernia repair deliver real-world data from very large patient populations and give answers to important clinical questions never evaluated in randomized controlled trials. Data from hernia registers can provide evidence of effectiveness of therapies in the general population. Hernia registers with high case load have existed in Sweden since 1992, in Denmark since 1998, and in Germany/Austria/Switzerland since 2009. In this review, the most important findings of register-based observational studies in inguinal hernia repair are presented. After an intensive literature search, 85 articles are relevant for this review. Numerous findings from these register-based studies have been incorporated into the various guidelines on inguinal hernia repair. These highlight the particular importance of hernia registers in answering key scientific and clinical questions in hernia surgery. The myriad of surgical techniques described – spanning more than 100 and with ongoing new additions – as well as the large number of associated medical devices call for, more than in other surgical disciplines, meticulous documentation of the methods used for the treatment of inguinal hernias.

Effect of Nursing Guidelines on Patients Undergoing Inguinal Hernia Repair Outcomes.

Inguinal hernia is a common type of hernia in which a loop of the intestine protrudes directly through a weak area of the abdominal wall in the groin region. This study aimed to assess the effect of nursing guidelines on patients undergoing inguinal hernia repair outcomes. A study was conducted in the general surgical departments at Assiut University Hospital. A consecutive sample of (60) patients was obtained. This sample was divided into study and control group (30) each. Tools utilized for data collection were interview questionnaire sheet and patients' evaluation sheet. Results showed that all the studied patients were male, aged above (30) years, married, manual workers and smokers. The level of patients' knowledge in study and control group preoperative was unsatisfactory (100%) while before discharge level of knowledge for study group was satisfactory (67.7%), also the level of complications decreased in study group than in control group. Conclusion: level of knowledge for patients who take designed nursing guidelines was higher than who didn't take any designed nursing guidelines also level of complications was lower in study group. Recommendation: each patient is given booklet include designed nursing guidelines about inguinal hernia disease and surgery .

The outcomes of elective versus emergency inguinal hernia repair in cirrhotic patients

Background Cirrhotic patients with ascites and Child classification B or C impose certain limitations on decision making as regards the elective repair of their inguinal hernias. The aim of this study was to evaluate and compare the outcomes of inguinal hernia repair in cirrhotic patients undergoing elective intervention and in those undergoing emergency interventions. Methods Fifty-six cirrhotic patients (Child B or C) undergoing inguinal hernia repair were evaluated. They were classified into two groups based on the type of intervention, elective and emergency surgical intervention (28 patients in each group). Patients were followed up for 12 months after surgery. Operative and postoperative outcomes and quality of life of these patients were recorded and analyzed. Results A total of eight (28.5%) patients died within 30 days after emergency hernia repair. One mortality was recorded in the first 30 days postoperatively in the elective group. Moreover, patients who underwent emergency patients presented with a significantly higher number of perioperative class III-V complications according to the Clavien-Dindo classification (60% in the emergency group vs. 7% in the elective group). Conclusion Elective inguinal hernia repair for cirrhotic patients with ascites is a relatively safe procedure. The improvement in quality of life represents a clear indication for elective hernia repair.

Outcome of Desarda repair in inguinal hernia: a study in northern part of Bangladesh

Background: Inguinal hernia repair by Desarda method provides a new concept of repair maintaining the physiology of inguinal canal. Repair without mesh gives another benefit of cost-effectiveness and freeing of foreign body–related complications. Objective: To observe the outcome of inguinal hernia repair by Desarda method as an alternative to most popular Lichtenstein repair. Materials and Methods: The longitudinal study was conducted from July 2012 to June 2015. A total of 184 patients with uncomplicated inguinal hernia were included in our study. After operation pain was assessed by visual analog score (VAS). In each follow-up, pain was scored and gait was assessed. Patients were seen during follow-up at 7 and 30 days, and 6, 12, and 24 months after surgery. The secondary outcomes were general and local complications, length of time to return to various levels of everyday activity, and abdominal wall stiffness in the groin area. SPSS, version 16.0, software programs were used for statistical calculation. Result: Of 184 patients recruited, 81% were men and 19% were women. Mean age was 45.42 years, SD ±10.08. A total of 63% patients in this study belong to low socioeconomic class. In the first postoperative day (POD), 73 patients felt mild pain and on third POD majority (168) felt only mild pain. Only 6.5% patients developed postoperative complications, mainly surgical site infection. A significant number of (49%) patients showed attribution of normal gait in second POD and 42% patients in third POD. A total of 98.37% patients had no complaint of chronic pain. 99% patients had no recurrence, and only 1% again developed inguinal hernia. Conclusion: As the outcome of this relatively new method is good. So, this physiologically sound technique can be widely practiced in our country as evident from our result.

The Impact of High Surgical Volume on Outcomes From Laparoscopic (Totally Extra Peritoneal) Inguinal Hernia Repair.

Laparoscopic hernia repair is characterised by a steep learning curve for the surgeon, and proficiency and outcomes are dependent on experience. The aim of this study was to compare laparoscopic totally extra peritoneal (TEP) inguinal hernia repair outcomes conducted by a single surgeon as experience changed over time. Clinical records of 100 consecutive patients who underwent laparoscopic TEP inguinal hernia repair (n=113 hernias) at Kent and Canterbury Hospital by a single laparoscopic surgeon over a four-year period were reviewed for postoperative outcomes. Outcomes were compared with a previous cohort of patients undergoing TEP repair in the preceding three years. One patient experienced chronic postoperative pain, but there were no recurrences, wound infections, haematomas, or conversions compared to three recurrences, three conversions to open operations, one haematoma, and one episode of postoperative pain in the preceding period. Laparoscopic TEP inguinal hernia repair can be further improved with surgical proficiency and high surgical volumes.

INGUINAL HERNIA REPAIR;

Objective: To compare the results of Inguinal Hernia repair using commonly employed methods of Bassini’s and Mesh repair. Methodology: This study included 90 cases of hernia repair ranging over a period of 18 months from October 2008 to Mar 2010 at Social Security Hospital Lahore. All the cases were done by the consultants and senior surgeons. The methods of repair included Bassini’s and Hernioplasty with Prosthetic mesh. Results: Out of 90 patients, 88 were males (97.78%) and 02 were females (2.22%). Male – female ratio 45 : 1. The peak incidence was found in 3rd and 4th decades of life. 56(62.22%) had Rt.sided Inguinal hernia, 29 (32.22%) had Lt. sided and 5(5.56%) had bilateral Inguinal hernia. 72 patients (80%) had Indirect Inguinal hernia, 17 (18.89%) had direct inguinal hernia while 1(1.11%) had both types. All the cases were done under Spinal anaesthesia. The Bassini’s repair was performed in 50% cases, using non-absorble no. 1 Prolene interrupted suturing (Group- A). In the Group – B, 50% cases underwent Hernioplasty with prosthetic prolene mesh 6x11 cms. Post-operative follow up was done for a period of 01 year. In the group- A, 3 (6.67%) patients had recurrence and 3 (6.67%) had infection of the wound. In group – B, 01 patient (2.22%) got infected and none of the cases did not get recurrence over a period of 01 year. Conclusions: Hernioplasty with prosthetic mesh is a better treatment modality for inguinal hernia repair to get a low recurrence rate.

Inguinal hernia repair outcomes that utilized the modified Kugel patch without the optional onlay patch: a case series of 163 consecutive patients.

The purpose of this study was to evaluate the efficacy and safety of the anterior Kugel herniorrhaphy approach when the onlay patch is omitted. The study population comprised patients who underwent anterior Kugel herniorrhaphy without the onlay patch from 1 May 2009, to 31 June 2012. The onlay patch was omitted if the posterior wall defect did not exceed the inner Posiflex(®) ring diameter. After reviewing the clinical follow-up records and conducting telephone interviews, the postoperative results were recorded and analyzed. A total of 163 patients underwent 175 hernia repairs. One patient developed recurrence after undergoing our herniorrhaphy method. The most common postoperative complaints were mild soreness, indescribable discomfort, and foreign body sensations (11 patients). The mean operative time and hospital stay were 67 min and 2 days, respectively. More serious complications included one scrotal hematoma, one hydrocele, and one wound infection that resulted in epididymitis. The onlay patch can be omitted with low recurrence and complication rates if the posterior wall defects do not exceed the inner Posiflex(®) ring diameter.

Prospective Randomized Trial of Long-Term Results of Inguinal Hernia Repair Using Autoadhesive Mesh Compared to Classic Lichtenstein Technique With Sutures and Polypropylene Mesh

IntroductionThe use of autoadhesive meshes with hooks that allow fixation without sutures is a therapeutic alternative to decrease recurrence and chronic pain after inguinal hernia repair. The aim of this study was to evaluate if this kind of mesh has any advantage in long term results in comparison with the classic Lichtenstein technique with sutures and polypropylene mesh. Materials and methodsWe report a prospective and randomized study of patients who have been operated on for inguinal hernia between March of 2009 to March 2010, divided into 2 groups of 45 patients. In autoadhesive (AA) group, we included patients operated on with an autoadhesive mesh and in classic Lichtenstein (CL) group we included cases with an inguinal hernioplasty with sutured polypropylene mesh. We evaluated time of inactivity, complications, recurrences and grade of pain after 1 year. ResultsThe mean age was 60 years in AA group and 49 in LC group. There were more men than women and there were no differences in co-morbidities between groups. The mean size of hernia orifice was 3cm in both groups and 60% of the hernias were indirect.After 1 year, 77 patients were evaluated, 39 in LC group and 38 in AA group. 86.8% and 87.2% of them were asymptomatic. The mean time of recovery of daily activities was 15 days in both groups. There were neither recurrences nor severe chronic pain in the AA group. The mean of grade of pain was 0 (range: 0–4) in AA group and 0 (range: 0–5) in LC group. In this group, there was one recurrence and one patient was taking analgesics for intense pain. Neither mortality nor other long term complications were found. ConclusionThe use of autoadhesive and parcial reabsorbible meshes in inguinal hernia repair has no effect on recovery of daily activities, postoperative pain and long term complications compared with hernioplasty with polypropylene mesh fixed with monofilament suture.

Comparison of the Outcomes of Inguinal Hernia Repair with Mesh and Non-Mesh Methods

Comparison of the Outcomes of Inguinal Hernia Repair with Mesh and Non-Mesh Methods

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

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. 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. 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. 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.