Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians

P. K. Pallati, P. K. Gupta, S. Bichala, H. Gupta, X. Fang, R. A. Forse

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80-89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality. Study design: Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2007-2008). Univariate analysis was performed using chi square, Fisher's exact test and t test. Multivariate logistic regression analysis was carried out to assess factors associated with increased postoperative complications and mortality. Results: Of 2,377 patients above 80 years of age, 226 (9.5 %) were nonagenarians. Men accounted for 81.4 % (1,936) of patients. There were significantly more female patients in the nonagenarian group (29.2 vs. 17.4 %, p <0.0001). Laparoscopic repair was performed in 210 (9.9 %) patients. Emergency repair was more frequent in nonagenarians than octogenarians (12 vs. 4.4 %, p <0.0001). The 30-day overall complication rate was significantly increased in nonagenarians compared to octogenarians (6.1 vs. 3.2 %, p = 0.03). Mortality is increased tenfold in elective inguinal hernia repair in nonagenarians compared to octogenarians (3 vs. 0.3 %, p <0.0005). On multivariate analysis, preoperative variables found to be significantly associated with morbidity included totally dependent functional status, congestive heart failure and emergent nature of procedure, while higher age, emergency repair and open wound are associated with increased mortality. Conclusions: Elective inguinal hernia repair can be safely performed in octogenarians with low morbidity and mortality but is increased in nonagenarians. More vigilant postoperative care is required after emergent hernia repairs due to the increased risk of morbidity and mortality, and effort should be made to electively repair inguinal hernias early in this elderly population.

Original languageEnglish
Pages (from-to)723-727
Number of pages5
JournalHernia : the journal of hernias and abdominal wall surgery
Volume17
Issue number6
DOIs
StatePublished - Dec 2013

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Inguinal Hernia
Herniorrhaphy
Mortality
Morbidity
Emergencies
Postoperative Care
Quality Improvement
Multivariate Analysis
Heart Failure
Logistic Models
Regression Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Surgery

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Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians. / Pallati, P. K.; Gupta, P. K.; Bichala, S.; Gupta, H.; Fang, X.; Forse, R. A.

In: Hernia : the journal of hernias and abdominal wall surgery, Vol. 17, No. 6, 12.2013, p. 723-727.

Research output: Contribution to journalArticle

Pallati, P. K. ; Gupta, P. K. ; Bichala, S. ; Gupta, H. ; Fang, X. ; Forse, R. A. / Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians. In: Hernia : the journal of hernias and abdominal wall surgery. 2013 ; Vol. 17, No. 6. pp. 723-727.
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abstract = "Background: The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80-89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality. Study design: Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2007-2008). Univariate analysis was performed using chi square, Fisher's exact test and t test. Multivariate logistic regression analysis was carried out to assess factors associated with increased postoperative complications and mortality. Results: Of 2,377 patients above 80 years of age, 226 (9.5 {\%}) were nonagenarians. Men accounted for 81.4 {\%} (1,936) of patients. There were significantly more female patients in the nonagenarian group (29.2 vs. 17.4 {\%}, p <0.0001). Laparoscopic repair was performed in 210 (9.9 {\%}) patients. Emergency repair was more frequent in nonagenarians than octogenarians (12 vs. 4.4 {\%}, p <0.0001). The 30-day overall complication rate was significantly increased in nonagenarians compared to octogenarians (6.1 vs. 3.2 {\%}, p = 0.03). Mortality is increased tenfold in elective inguinal hernia repair in nonagenarians compared to octogenarians (3 vs. 0.3 {\%}, p <0.0005). On multivariate analysis, preoperative variables found to be significantly associated with morbidity included totally dependent functional status, congestive heart failure and emergent nature of procedure, while higher age, emergency repair and open wound are associated with increased mortality. Conclusions: Elective inguinal hernia repair can be safely performed in octogenarians with low morbidity and mortality but is increased in nonagenarians. More vigilant postoperative care is required after emergent hernia repairs due to the increased risk of morbidity and mortality, and effort should be made to electively repair inguinal hernias early in this elderly population.",
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T1 - Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians

AU - Pallati, P. K.

AU - Gupta, P. K.

AU - Bichala, S.

AU - Gupta, H.

AU - Fang, X.

AU - Forse, R. A.

PY - 2013/12

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N2 - Background: The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80-89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality. Study design: Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2007-2008). Univariate analysis was performed using chi square, Fisher's exact test and t test. Multivariate logistic regression analysis was carried out to assess factors associated with increased postoperative complications and mortality. Results: Of 2,377 patients above 80 years of age, 226 (9.5 %) were nonagenarians. Men accounted for 81.4 % (1,936) of patients. There were significantly more female patients in the nonagenarian group (29.2 vs. 17.4 %, p <0.0001). Laparoscopic repair was performed in 210 (9.9 %) patients. Emergency repair was more frequent in nonagenarians than octogenarians (12 vs. 4.4 %, p <0.0001). The 30-day overall complication rate was significantly increased in nonagenarians compared to octogenarians (6.1 vs. 3.2 %, p = 0.03). Mortality is increased tenfold in elective inguinal hernia repair in nonagenarians compared to octogenarians (3 vs. 0.3 %, p <0.0005). On multivariate analysis, preoperative variables found to be significantly associated with morbidity included totally dependent functional status, congestive heart failure and emergent nature of procedure, while higher age, emergency repair and open wound are associated with increased mortality. Conclusions: Elective inguinal hernia repair can be safely performed in octogenarians with low morbidity and mortality but is increased in nonagenarians. More vigilant postoperative care is required after emergent hernia repairs due to the increased risk of morbidity and mortality, and effort should be made to electively repair inguinal hernias early in this elderly population.

AB - Background: The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80-89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality. Study design: Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2007-2008). Univariate analysis was performed using chi square, Fisher's exact test and t test. Multivariate logistic regression analysis was carried out to assess factors associated with increased postoperative complications and mortality. Results: Of 2,377 patients above 80 years of age, 226 (9.5 %) were nonagenarians. Men accounted for 81.4 % (1,936) of patients. There were significantly more female patients in the nonagenarian group (29.2 vs. 17.4 %, p <0.0001). Laparoscopic repair was performed in 210 (9.9 %) patients. Emergency repair was more frequent in nonagenarians than octogenarians (12 vs. 4.4 %, p <0.0001). The 30-day overall complication rate was significantly increased in nonagenarians compared to octogenarians (6.1 vs. 3.2 %, p = 0.03). Mortality is increased tenfold in elective inguinal hernia repair in nonagenarians compared to octogenarians (3 vs. 0.3 %, p <0.0005). On multivariate analysis, preoperative variables found to be significantly associated with morbidity included totally dependent functional status, congestive heart failure and emergent nature of procedure, while higher age, emergency repair and open wound are associated with increased mortality. Conclusions: Elective inguinal hernia repair can be safely performed in octogenarians with low morbidity and mortality but is increased in nonagenarians. More vigilant postoperative care is required after emergent hernia repairs due to the increased risk of morbidity and mortality, and effort should be made to electively repair inguinal hernias early in this elderly population.

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