V. Jain1, M. S. Sultany1, T. Madni1, S. Huerta1,2 1University Of Texas Southwestern Medical Center,General Surgery,Dallas, TX, USA 2VA North Texas Health Care System,General Surgery,Dallas, TX, USA
Introduction: Elective inguinal hernia repair (IHR) in elderly patients might still cause apprehension in general surgerons especially in the era of acceptable watchful waiting. Reports also indicate that elective rather than emergent operations should be performed for octogenarians presenting with an IH. We elected to interrogate a data base in veteran patients that controls for institution and surgeon. We hypothesize that outcomes are similar independent of age.
Methods: This is a retrospective review of data from a single institution and by a single surgeon. We reviewed the entire database for outcomes of IHR on all age groups between July 2005 and April 2016, which included 933 patients and over 1000 IHR. We separated octogenarians (80-89 years) and nonagenarians (90-99yrs) (Group 1) from everyone else under 80 years (Group 2) and proceeded to compare the two groups with primary outcome studied being major complications (Inguinodynia and Recurrence) and secondary outcomes being all other morbidities/minor complications. Descriptive statistics have been used for patient demographics, X2 was used for comparison of categorical data and student t- test was used for continuous variables.
Results: Of the 933 patients, 57 (6.1 %) were octogenarians and 2 (0.2%) were nonagenarians. Mean age in group 1 was 83.68 ± 3.02 years and in group 2 was 59.28 ± 11.35 years. Both groups: Men=99.8%. Group I vs group II: bilateral IH=8.4% vs 8.5% (p=0.97), Incarcerated IH 18 % vs 6.0% (p <0.01), BMI 24.93 ± 3.36 vs. 27.06 ± 10.21 kg/m2 (p=0.06), ASA I/II 20% vs. 49.4 % (p< 0.01), ASA III/IV 79.2%, vs. 49.2% (p< 0.01). OR time 62.59 ± 21.38 min vs. 60.26 ± 23.77 min for unilateral repairs (p=0.22) and 132.8 ± 35.29 min vs. 103.4 ± 25.62 min for bilateral repair (p=0.07). Rate of inguinodynia was 0% vs. 1.9% (p=0.27), recurrence rate was 1.7% vs 0.8% (p=0.47). Minor complications were more common in group I (20.3% vs. 9.38% (p=0.006). Length of stay (LOS)=1.23 ± 5.99 d vs. 0.28 ± 2.01 d (p=0.23), LOS > 2d=8.47% vs 2.4% (p=0.006). Multivariate analysis did not identify and independent predictors of major or minor complications.
Conclusion: There is no significant difference in the incidence of major complications for IHR in the octogenarian population. There is a significantly higher incidence of minor complications and prolonged length of stay in the octogenarian population compared to the younger age group as observed by univariate analysis.