Should we perform elective inguinal hernia repair in the elderly?
Purpose 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. Methods We performed a retrospective rev...
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| Veröffentlicht in: | Hernia : the journal of hernias and abdominal wall surgery 2017-02, Vol.21 (1), p.51-57 |
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| creator | Wu, J. J. Baldwin, B. C. Goldwater, E. Counihan, T. C. |
| description | Purpose
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.
Methods
We performed a retrospective review of the 2011 NSQIP database evaluating 19,683 patients undergoing IHR. Patients were divided by age into three categories: 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.
Results
There were 17,375 male patients (88 %). 92.7 % were elective. 70 % were performed using an open technique. Age distribution was 63.4 % 80. Mortality was similar across age groups in elective repair. Mortality was increased in emergency repair in all age groups (
p
80 (OR = 57,
p
|
| doi_str_mv | 10.1007/s10029-016-1517-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1868309886</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826724546</sourcerecordid><originalsourceid>FETCH-LOGICAL-c471t-12ec4efc8ad835aabbcc7c7d4aecf7898da28e9b38b91ce69e96964aa82911c13</originalsourceid><addsrcrecordid>eNqNkU1Lw0AQhhdRbK3-AC8S8OIlul_Zj5OU4hcUPKjnZbOZtClpUncbpf_eja0iguBlZth55l1mXoROCb4kGMurECPVKSYiJRmRKdtDQ0K5SjXFfL-vRZZyjcUAHYWwwBgrLtQhGlDJmZKaDdH4ad52dZG8Q7ICX7Z-mUANbl29QVI1s65qbJ3MwTeVTTysbOXjc7KeQ8QK8PXm-hgdlLYOcLLLI_Rye_M8uU-nj3cPk_E0dVySdUooOA6lU7ZQLLM2z52TThbcgiul0qqwVIHOmco1cSA0aKEFt1ZRTYgjbIQutror3752ENZmWQUHdW0baLtgiBKKYa2U-AdKhaQ84z16_gtdtJ2PS38KZjRjjNBIkS3lfBuCh9KsfLW0fmMINr0VZmuFiVaY3grD4szZTrnLl1B8T3zdPgJ0C4TYambgf3z9p-oHi4CS2w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1865253312</pqid></control><display><type>article</type><title>Should we perform elective inguinal hernia repair in the elderly?</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Wu, J. J. ; Baldwin, B. C. ; Goldwater, E. ; Counihan, T. C.</creator><creatorcontrib>Wu, J. J. ; Baldwin, B. C. ; Goldwater, E. ; Counihan, T. C.</creatorcontrib><description>Purpose
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.
Methods
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.
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. 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).
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.</description><identifier>ISSN: 1265-4906</identifier><identifier>EISSN: 1248-9204</identifier><identifier>DOI: 10.1007/s10029-016-1517-3</identifier><identifier>PMID: 27438793</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Abdominal Surgery ; Age Factors ; Aged ; Aged, 80 and over ; Databases, Factual ; Elective Surgical Procedures - adverse effects ; Elective Surgical Procedures - mortality ; Elective Surgical Procedures - statistics & numerical data ; Female ; Hernia, Inguinal - surgery ; Herniorrhaphy - adverse effects ; Herniorrhaphy - mortality ; Herniorrhaphy - statistics & numerical data ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Retrospective Studies ; Risk Factors ; United States - epidemiology</subject><ispartof>Hernia : the journal of hernias and abdominal wall surgery, 2017-02, Vol.21 (1), p.51-57</ispartof><rights>Springer-Verlag France 2016</rights><rights>Hernia is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-12ec4efc8ad835aabbcc7c7d4aecf7898da28e9b38b91ce69e96964aa82911c13</citedby><cites>FETCH-LOGICAL-c471t-12ec4efc8ad835aabbcc7c7d4aecf7898da28e9b38b91ce69e96964aa82911c13</cites><orcidid>0000-0002-9208-0882</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10029-016-1517-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10029-016-1517-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27438793$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wu, J. J.</creatorcontrib><creatorcontrib>Baldwin, B. C.</creatorcontrib><creatorcontrib>Goldwater, E.</creatorcontrib><creatorcontrib>Counihan, T. C.</creatorcontrib><title>Should we perform elective inguinal hernia repair in the elderly?</title><title>Hernia : the journal of hernias and abdominal wall surgery</title><addtitle>Hernia</addtitle><addtitle>Hernia</addtitle><description>Purpose
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.
Methods
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.
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. 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).
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.</description><subject>Abdominal Surgery</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Databases, Factual</subject><subject>Elective Surgical Procedures - adverse effects</subject><subject>Elective Surgical Procedures - mortality</subject><subject>Elective Surgical Procedures - statistics & numerical data</subject><subject>Female</subject><subject>Hernia, Inguinal - surgery</subject><subject>Herniorrhaphy - adverse effects</subject><subject>Herniorrhaphy - mortality</subject><subject>Herniorrhaphy - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>United States - epidemiology</subject><issn>1265-4906</issn><issn>1248-9204</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkU1Lw0AQhhdRbK3-AC8S8OIlul_Zj5OU4hcUPKjnZbOZtClpUncbpf_eja0iguBlZth55l1mXoROCb4kGMurECPVKSYiJRmRKdtDQ0K5SjXFfL-vRZZyjcUAHYWwwBgrLtQhGlDJmZKaDdH4ad52dZG8Q7ICX7Z-mUANbl29QVI1s65qbJ3MwTeVTTysbOXjc7KeQ8QK8PXm-hgdlLYOcLLLI_Rye_M8uU-nj3cPk_E0dVySdUooOA6lU7ZQLLM2z52TThbcgiul0qqwVIHOmco1cSA0aKEFt1ZRTYgjbIQutror3752ENZmWQUHdW0baLtgiBKKYa2U-AdKhaQ84z16_gtdtJ2PS38KZjRjjNBIkS3lfBuCh9KsfLW0fmMINr0VZmuFiVaY3grD4szZTrnLl1B8T3zdPgJ0C4TYambgf3z9p-oHi4CS2w</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Wu, J. J.</creator><creator>Baldwin, B. C.</creator><creator>Goldwater, E.</creator><creator>Counihan, T. C.</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9208-0882</orcidid></search><sort><creationdate>20170201</creationdate><title>Should we perform elective inguinal hernia repair in the elderly?</title><author>Wu, J. J. ; Baldwin, B. C. ; Goldwater, E. ; Counihan, T. C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-12ec4efc8ad835aabbcc7c7d4aecf7898da28e9b38b91ce69e96964aa82911c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Databases, Factual</topic><topic>Elective Surgical Procedures - adverse effects</topic><topic>Elective Surgical Procedures - mortality</topic><topic>Elective Surgical Procedures - statistics & numerical data</topic><topic>Female</topic><topic>Hernia, Inguinal - surgery</topic><topic>Herniorrhaphy - adverse effects</topic><topic>Herniorrhaphy - mortality</topic><topic>Herniorrhaphy - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wu, J. J.</creatorcontrib><creatorcontrib>Baldwin, B. C.</creatorcontrib><creatorcontrib>Goldwater, E.</creatorcontrib><creatorcontrib>Counihan, T. C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wu, J. J.</au><au>Baldwin, B. C.</au><au>Goldwater, E.</au><au>Counihan, T. C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Should we perform elective inguinal hernia repair in the elderly?</atitle><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle><stitle>Hernia</stitle><addtitle>Hernia</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>21</volume><issue>1</issue><spage>51</spage><epage>57</epage><pages>51-57</pages><issn>1265-4906</issn><eissn>1248-9204</eissn><abstract>Purpose
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.
Methods
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.
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. 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).
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.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>27438793</pmid><doi>10.1007/s10029-016-1517-3</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9208-0882</orcidid></addata></record> |
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| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Age Factors Aged Aged, 80 and over Databases, Factual Elective Surgical Procedures - adverse effects Elective Surgical Procedures - mortality Elective Surgical Procedures - statistics & numerical data Female Hernia, Inguinal - surgery Herniorrhaphy - adverse effects Herniorrhaphy - mortality Herniorrhaphy - statistics & numerical data Humans Male Medicine Medicine & Public Health Middle Aged Original Article Retrospective Studies Risk Factors United States - epidemiology |
| title | Should we perform elective inguinal hernia repair in the elderly? |
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