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Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 128-137

Inguinal and femoral hernia repair in octogenarians and nonagenarians – A population-based analysis

1 University Hospital Basel; Department of Visceral Thorax and Vascular Surgery, Cantonal Hospital Olten, Switzerland
2 University Hospital Basel; Department of Surgery, Hospital Dornach, Switzerland
3 University Hospital Basel; Zweichirurgen Basel - Center for Hernia Surgery and Proctology, Basel, Switzerland
4 University Hospital Basel; Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, Clarunis, Basel, Switzerland

Correspondence Address:
Dr. Philippe Glauser
Department of Surgery, Hospital Dornach, Basel
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijawhs.ijawhs_31_20

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PURPOSE: Our primary aim was to evaluate the inhospital mortality (IHM) of elderly patients undergoing inguinal or femoral hernia repair (groin hernia repair GHR), since this growing population is associated with increased perioperative risks. MATERIALS AND METHODS: Totally 179,806 patients undergoing GHR between 2005 and 2015 in Switzerland were divided into three cohorts: <80, 80–89, and ≥90 (years). IHM for each was compared and stratified according to: type of admission, hernia, surgical approach, and whether a bowel resection was performed. A multivariate analysis controlling for age, gender, type of hernia, admission, and comorbidities was performed. RESULTS: The elderly (>80 years) represent 8.86% (n = 15,750) of our sample. The IHM for elective GHR in these patients is low (0.15% for octogenarians and 0.8% for nonagenarians). For emergency surgery, it increases substantially (4.1% and 7.5%, respectively). In emergency cases with a combined bowel resection (n = 755), the IHM has a fivefold increase for nonagenarians when compared to the younger population. The IHM was significantly higher with femoral hernia repair, especially in the elderly (4.75% – octogenarians and 11.4% – nonagenarians). When adjusting for other variables, there is a twofold risk of death with femoral hernia repair. Patients with a Charlson Comorbidity Index (CCI) ≥2 have a 7.5 times higher risk of dying after GHR. All of these results were statistically significant (P < 0.0001). CONCLUSIONS: This retrospective analysis highlights the increased operative risk in emergency compared to elective GHR in the elderly. This should be considered when opting for watchful waiting in minimally symptomatic octo- and nonagenarians.

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