Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 1/2017

01-02-2017 | Original Article

Should we perform elective inguinal hernia repair in the elderly?

Authors: J. J. Wu, B. C. Baldwin, E. Goldwater, T. C. Counihan

Published in: Hernia | Issue 1/2017

Login to get access

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.
Literature
1.
Matthew RD, Neumayer L (2008) Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg 45:261–312CrossRef
2.
Arias E (2012) US life tables, 2008. National Vital Statistics Reports; vol 61 no.3, Hyattsville, MD, USA
3.
National Center for Health Statistics National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat 165:001–209
4.
Hamel MD, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients age 80 and older: morbidity and mortality from non-cardiac surgery. J Am Geriatr Soc 53:424–429CrossRefPubMed
5.
6.
Pallati PK, Gupta PK, Bichala S, Gupta H, Fang X, Forse RA (2013) Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians. Hernia 17:723–727CrossRefPubMed
7.
Abi-Haidar Y, Sanchez V, Itani K (2011) Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 213(3):363–369CrossRefPubMed
8.
Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25(4):835–839CrossRefPubMed
9.
INCA Trialist Collaboration (2011) Operation compared with watchful waiting in elderly male inguinal hernia patients: a review and data analysis. J Am Coll Surg 212(2):251–259CrossRef
10.
Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F (2001) Emergency hernia repairs in elderly patients. Am J Surg 182:455–459CrossRefPubMed
11.
Ohana G, Manevwitch I, Weil R, Melki Y, Seror D, Powsner E, Dreznik Z (2004) Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients. Hernia 8:117–120CrossRefPubMed
12.
O’Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P (2006) Observation or operation for patients with an asymptomatic inguinal hernia. Ann Surg 244(2):167–173CrossRefPubMedPubMedCentral
13.
Fitzgibbons RJ Jr, Biobbie-Hurder A, Gibbs J, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JST, Hoehn JL, Murphy JT, Sarosi GA, Syme WC, Thompson JS, Wang JW, Jonasson O (2006) Watchful waiting versus repair of inguinal hernia in minimally symptomatic men. JAMA 295(3):285–292CrossRefPubMed
14.
Fitzgibbons RJ Jr, Ramanan B, Arya S, Turner SA, Li X, Gibbs JO, Reda DJ, Investigators of the Original Trial (2013) Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 258(3):508–515CrossRefPubMed
15.
McEntee GP, O’Carroll A, Mooney B, Egan TJ, Delaney PV (1989) Timing of strangulation in adult hernias. Br J Surg 76:725–726CrossRefPubMed
16.
Alvarez JA, Baldonedo RF, Bear IG, Solis JAS, Alvarez P, Jorge JI (2004) Incarcerated groin hernias in adults: presentation and outcome. Hernia 8:121–126CrossRefPubMed
17.
Gianetta E, De Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G (1997) Hernia repair in elderly patients. Br J Surg 84:983–985CrossRefPubMed
18.
Nienhuijs SW, Remijn EEG, Rosman C (2005) Hernia repair in elderly patients under unmonitored local anaesthesia is feasible. Hernia 9:218–222CrossRefPubMed
19.
Callesen T, Bech K, Kehlet H (2001) One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Anesth Analg 93:1373–1376CrossRefPubMed
20.
Malek S, Torella F, Edwards PR (2004) Emergency repair of groin herniae: outcomes and implications for elective surgery waiting times. Int J Clin Pract 58(2):207–209CrossRefPubMed
21.
Simons MP, Aufenacker T, Bay-Nielson M, Bouillot JL, Campanelli G, Conze J, deLange D, Fortlny R, Heikkinen R, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403CrossRefPubMedPubMedCentral
22.
Stroupe KT, Manheim LM, Luo P, Giobbie-Hurder A, Hynes DM, Jonasson O, Reda DJ, Gibbs JO, Dunlop DD, Fitzgibbons RJ Jr (2006) Tension-free repair versus watchful waiting for men with asymptomatic or minimally symptomatic inguinal hernias: a cost-effectiveness analysis. JACS 203:458–468
23.
Thompson JS, Gibbs JO, Reda DJ, McCarthy M Jr, Wei Y, Giobbie-Hurder A, Fitzgibbons RJ Jr (2008) Does delaying repair of an asymptomatic hernia have a penalty? Am J Surg 195:89–93CrossRefPubMed
24.
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W, For the Veterans Affairs Cooperative Studies Program 456 Investigators (2004) Open versus laparoscopic mesh repair of inguinal hernia. NEJM 350(18):1819–1827CrossRefPubMed
25.
Hope WW, Bools L, Menon A, Scott III CM, Adams A, Hooks III WB (2013) Comparing open and laparoscopic inguinal hernia repair in octogenarians. Hernia 17:719–722CrossRefPubMed
26.
Matthews RD, Anthony T, Kim LT, Wang J, Fitzgibbons RJ Jr, Giobbie-Hurder A, Reda DJ, Itani KMF, Neumayer LA, For the Veterans Affairs Cooperative 456 Studies Program Investigators (2007) Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Am J Surg 194:611–617CrossRefPubMed
27.
Saleh F, Okrainec A, D’Souza N, Kwong J, Jackson T (2014) Safety of laparoscopic and open approaches for repair of the unilateral primary inguinal hernia: an analysis of short-term outcomes. Am J Surg 208:195–201CrossRefPubMed
28.
Smink DS, Paquette IM, Finlayson SRG (2009) Utilization of laparoscopic and open Inguinal hernia repair: a population-based analysis. J Laparoendosc Adv Surg Tech 19(6):745–748CrossRef
29.
Bourgon AL, Fox JP, Saxe JM, Woods RJ (2015) Outcomes and charges associated with outpatient inguinal hernia repair according to method of anesthesia and surgical approach. Am J Surg 209:468–472CrossRefPubMed
Metadata
Title
Should we perform elective inguinal hernia repair in the elderly?
Authors
J. J. Wu
B. C. Baldwin
E. Goldwater
T. C. Counihan
Publication date
01-02-2017
Publisher
Springer Paris
Published in
Hernia / Issue 1/2017
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-016-1517-3

Other articles of this Issue 1/2017

Hernia 1/2017 Go to the issue

Original Article

Whole-exome sequencing identifies a potential TTN mutation in a multiplex family with inguinal hernia

Original Article

First 200 consecutive transumbilical single-incision laparoscopic TEPs

Original Article

Mesh shrinkage depends on mesh properties and anchoring device: an experimental long-term study in sheep

How-I-Do-It

Sports hernia repair with adductor tenotomy

Original Article

Outcomes of hypnosis combined with local anesthesia during inguinal repair: a pilot study

ACKNOWLEDGEMENT TO REFEREES

Acknowledgement to referees 2016