Inguinal hernia repair in a community setting: implications for the elderly.

ABSTRACT

OBJECTIVE: Inguinal hernia repair is thought to be a relatively low morbidity operation. This study examined whether this tenet hold true in patients who are elderly with significant comorbidity. DESIGN: Case series. Retrospective review of a prospectively collected database. SETTING: Single surgeon practicing in Vermont over a period of 9 years. PATIENTS Consecutive sample of 2,145 inguinal herniorraphies in 1,889 patients. INTERVENTION Patients underwent an open inguinal hernia repair with mesh placement. A total of 81% of the repairs were performed under local anesthesia with intravenous sedation. MAIN OUTCOME MEASURE: Presence of comorbid conditions and complications were compared between patients younger and older than 65 years. RESULTS: A total of 2,145 herniorraphies were performed on 1,889 patients (1,646 in younger patients and 499 in older patients). Hernia repairs in older patients were more likely associated with comorbid conditions than in their younger counterparts (74 vs 39%; OR = 4.55, P < 0.0001). Specifically, hypertension (26 vs 9%; OR = 3.5, P < 0.0001), coronary artery disease (34 vs 6%; OR = 8.4, P < 0.0001) and benign prostatic hypertrophy (26 vs 4%; OR = 8.2, P < 0.0001) were more commonly present in older individuals. The commonest postoperative complications in both groups were recurrence (3%), hematoma (1%) and nerve entrapment (1%). There were no deaths. There was no significant difference in the rate of postoperative complications (6 vs 7%; OR = 0.95, P = 0.88) or recurrence rates (2 vs 3%; OR = 0.82, P = 0.65) between groups. CONCLUSION: Inguinal herniorrhaphy under local anesthesia is a safe operation with a high success rate in the elderly. Patients with significant comorbidities are not at higher risk of complications or recurrences.