Elderly and octogenarian cohort: Comparable outcomes with nonelderly cohort after open or laparoscopic inguinal hernia repairs

• Published in: Surgery Vol. 158; no. 4; pp. 1137 - 1144
• Main Authors: Vigneswaran, Yalini, MD, Gitelis, Matthew, BS, Lapin, Brittany, MPH, Denham, Woody, MD, Linn, John, MD, Carbray, Joann, BS, Ujiki, Michael, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Age Factors; Aged; Aged, 80 and over; Female; Hernia, Inguinal - surgery; Herniorrhaphy - methods; Humans; Laparoscopy; Length of Stay - statistics & numerical data; Male; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Recurrence; Surgery; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2015.08.002

Purpose To understand whether the elderly (>65 years of age) or octogenarian cohort is at greater risk for poor clinical outcomes after open or laparoscopic inguinal hernia repairs. Methods Beginning in June 2009, all patients presenting to our institution for inguinal hernia repair were asked to participate in a prospective database. Demographics, presenting symptoms, preoperative findings on examination, intraoperative variables, postoperative outcomes, and readmission data were collected. Additionally, patient-centered outcomes were evaluated with the Short Form-36 and Carolina Comfort Score questionnaires at follow-up visits (3 weeks, 6 months, 1 year, and for the Short Form-36 preoperatively as well). Results A total of 471 patients were included in the study; 285 were nonelderly, 155 patients were aged 65–80 years, and 31 patients were older than 80 years of age. Of these patients, the percent who underwent laparoscopic repair was 86% for the nonelderly, 79% for the elderly, and 41.9% for the octogenarian cohorts ( P < .001). After laparoscopic repairs, the older cohorts had greater rates of minor postoperative complications than the nonelderly cohort (38% and 58% vs 15%; P < .001) attributable to greater rates of seroma and urinary retention. Intraoperative complications and recurrence rates were not different among the cohorts; however, the octogenarian cohort was more likely to be readmitted compared with both the nonelderly and elderly cohorts (17% vs 2% and 2%, respectively, P < .001) and to have a greater duration of stay ( P < .001). For laparoscopic repairs over all the cohorts, the Carolina Comfort Scale improved over time ( P < .001). Laparoscopic repairs in the octogenarians ( P  = .07) but not in the elderly ( P = .6) had better scores over time (8.1 and 1.0 and points less/better, respectively) than the nonelderly cohort. Conclusion Laparoscopic inguinal hernia repair is safe and effective in elderly and octogenarian patients with no major morbidities or mortalities. Although these patients are at greater risk for postoperative seroma and urinary retention, and octogenarians are at greater risk for readmission, patient-centered outcomes may be better after laparoscopic repairs with the proper patient selection in the older population.