Ventral hernia repairs in the oldest-old: high-risk regardless of approach

Background

Ventral hernia repairs (VHR) are among the most common procedures performed by general surgeons. Even though the US population is aging, outcomes of VHR in the elderly and oldest-old (≥80 years) are not well documented. Our study aims to evaluate the short-term outcomes of VHR in the oldest-old patients.

Methods

The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent VHR based on Current Procedural Terminology codes between 2005 and 2011. Chi square, Fisher’s exact and two-tailed Student’s t test were used to compare baseline characteristics and outcomes. Binary logistic regression was used to control for confounding variables. Odds ratios (OR) with 95 % confidence intervals (CI) were reported when applicable.

Results

We identified 123,151 patients who underwent a VHR; 4,917 (4 %) were ≥80 years of age. The incidence of laparoscopy increased from 19.8 % in 2009–23.2 % in 2011 (p < 0.001). 30-day unadjusted mortality was 1.7 versus 0.1 % for younger patients (p < 0.001). After controlling for baseline differences, age ≥80 years was an independent predictor of overall morbidity (OR 1.4, 95 % CI 1.3–1.6, p < 0.001), serious morbidity (OR 1.6, 95 % CI 1.4–1.8, p < 0.001) and mortality (OR 3.5, 95 % CI 2.5–4.6, p < 0.001). Oldest-old patients undergoing laparoscopic VHR had a lower incidence of surgical site infection (SSI) compared with patients with open repair (1 vs. 3.4 %, p = 0.001). Mortality, serious morbidity and overall morbidity were not significantly different.

Conclusions

VHR in the oldest-old carried significantly higher 30-day overall morbidity, serious morbidity and mortality, compared with younger patients. The use of laparoscopy was associated with improved SSI. Mortality and morbidity were associated with emergency surgery, wound classification and baseline comorbidities, but not surgical approach.