S. Hinks1, S. Sakowitz1, E. Aguayo1,2, T. Coaston1, G. Porter1, K. Tabibian1, A. Chaturvedi1, A. Tillou1,3, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles, Center For Advanced Surgical & Interventional Technology (CASIT), Los Angeles, CA, USA 2Los Angeles County Harbor-UCLA, Department Of Surgery, Torrance, CA, USA 3David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Surgery, Los Angeles, CA, USA
Introduction:
Advances in operative techniques and perioperative management have expanded the scope of emergent hernia repair to include elderly patients. As the prevalence of dementia within an aging population rises, its impact on surgical outcomes, particularly in emergent settings, is a growing concern. We aimed to evaluate the association between dementia and outcomes following emergent hernia repair.
Methods:
A retrospective analysis was performed of patients (≥65 years) undergoing non-elective hernia repair using the Nationwide Readmissions Database from 2016-2021. Patients were stratified based on pre-existing dementia. The primary outcome evaluated was in-hospital mortality. Secondary outcomes included perioperative complications, non-home discharge, and non-elective 30-day readmission. Entropy balancing was performed to generate sample weights that adjust for baseline differences. Multivariable models were used to analyze outcomes.
Results:
Of an estimated 137,755 patients undergoing emergent hernia repair, 8.2% had dementia. The proportion of patients with dementia remained stable during the study period (nptrend=0.98). The most common operative approach was open (82.4%), followed by laparoscopic (13.7%) and robotic-assisted (3.9%). From 2016-2021, the use of open approach decreased (85.1 to 79.3%), while the robotic-assisted approach increased (0.9 to 7.1%) (both nptrend<0.001). When compared to others, patients with dementia were generally older (84 [78-88] vs 75 [70-82] years), more often of male sex (50.0 vs 47.0%), and more frequently insured by Medicare (94.0 vs 89.6%) (all P<0.05). Additionally, they had a higher burden of comorbidities (Elixhauser Index: 3 [2-5] vs 3 [2-4]), including psychiatric disorders (17.8 vs 10.0%) (both P<0.05). After multivariable adjustment, dementia was associated with an increased risk of in-hospital mortality (AOR 1.29, 95%CI 1.12-1.49). When assessed by age, risk-adjusted mortality remained higher for patients with dementia aged ≥75 years (Figure). Additionally, dementia was independently associated with a greater likelihood of overall perioperative complications (AOR 1.41, 95%CI 1.32-1.50), non-home discharge (AOR 2.98, 95%CI 2.80-3.18), and readmission (AOR 1.11, 95%CI 1.01-1.22).
Conclusion:
Dementia appears to be associated with inferior outcomes following emergent hernia repair, especially among elderly patients. Our findings highlight the need for heightened perioperative management and targeted strategies to optimize care in this population.