Predictors of long-term mortality in octogenarian veterans following inguinal hernia repair

The feasibility and safety of laparoscopic inguinal hernia repair as a 24-h day surgery for patients aged 80 years and older: a retrospective cohort study

INTRODUCTION

As the proportion of aging adults increases and inguinal hernia repair becomes increasingly popular as a day surgery, the demand for laparoscopic inguinal hernia repair as a day surgery is increasing among patients aged 80 years and older. Relevant research needs to be completed, so we aimed to evaluate laparoscopic inguinal hernia repair as a 24-h day surgery for this group of patients.

METHODS

In this retrospective cohort study, we utilized propensity score matching to analyze the data of patients who underwent laparoscopic inguinal hernia repair at a day surgery center between January 1, 2019, and March 1, 2022. Patients were divided into ≥ 80 years old and < 80 years old groups. We compared the perioperative laboratory results, perioperative outcomes, and 1-year complications between the two groups.

RESULT

A total of 554 patients were included in the study. After propensity score matching, 292 patients were included in the matched cohort (98 patients in the ≥ 80 years old group and 194 patients in the < 80 years old group). During hospitalization, there were significant differences in ASA classification, Caprini score, length of hospital stays, risk of thrombosis, and delayed discharge rate. No significant difference was found in the incidence of total postoperative complications between the two groups at the 1-year follow-up (HR: 0.96, 95% CI 0.36-2.54, P = 0.96).

CONCLUSION

In our study, LIHR as a 24-h day surgery was safe and effective for patients over 80 years old. However, to reduce the rate of delayed discharge, cautious perioperative evaluation is necessary.

The VASQIP Calculator is a poor predictor of morbidity and mortality in octogenarian and nonagenarian veterans undergoing major lower extremity amputations

BACKGROUND

Morbidity and mortality for major (above the ankle) lower extremity amputation (LEA) is high in veteran patients and age is a predictor of mortality. The Veteran Affair Surgical Quality Improvement Program (VASQIP) risk assessment tool has been validated for several operations, but not for elderly patients undergoing LEA. The present study interrogated the accuracy for the VASQIP calculator for a medium/high-risk operation in a high-risk veteran population (octogenarians and nonagenarians).

METHODS

Variables required from input for the VASQIP calculator were retrospectively obtained for 57 octogenarians and 11 nonagenarians submitting to LEA at our institution from (2009 to 2021). The six-outcome variables provided by the VASQIP calculator (30-d mortality; 180-d mortality; 30-day morbidity; 30-day SSI risk; probability of ICU stay; probability of hospital stay) were compared to observed morbidity and mortality. The accuracy of the calculator was assessed by area under the receiver operating characteristic curve and reported by the area under the curve (AUC) as previously described.

RESULTS

In the 68 patients included in this analysis, the time to death from the last index operation was 422.0 ± 604.9 days for octogenarians and 65.6 ± 89.3 days for nonagenarians. Predicted vs. observed 30-d mortality for octogenarians and nonagenarians was 8.46 vs. 24.56 [AUC=0.739; 95% CI (0.581 to 0.898)] and 24.46 vs. 45.45 [AUC=0.600 (0.171 to 1.000); respectively]. Predicted vs. observed 180-d mortality for the same cohorts was 25.22 vs. 47.37 [AUC=0.578 (0.427 to 0.728)] and 45.34 vs. 90.91 [AUC=0.100 (0.000 to 0.286); respectively]. Thirty-day morbidity, 30-day SSI, probability of ICU and probability of in-hospital stay produced an AUC below 0.600 for all these outcomes.

CONCLUSION

The VASQIP risk calculator is a poor predictor of short-term outcomes in octogenarians and nonagenarians undergoing major LEA. Most octogenarian and nonagenarian veterans died within 1 year, and the mean survival for nonagenarians was less than 3 months after LEA. The decision for major LEA in octogenarian and nonagenarian veterans warrants informed discussion with the patient and family.