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Liu J, Zhang H, Qiao X, Wu M, Wang H, Ran K, Luo H, Chen Y, Sun J, Tang B. 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. Hernia 2023; 27:1533-1541. [PMID: 37898974 DOI: 10.1007/s10029-023-02912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/08/2023] [Indexed: 10/31/2023]
Abstract
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.
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Affiliation(s)
- J Liu
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - H Zhang
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - X Qiao
- The Second Clinical Medical College of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - M Wu
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - H Wang
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - K Ran
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - H Luo
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - Y Chen
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - J Sun
- Vascular, Hernia and Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, China
| | - B Tang
- The Fourth Clinical College of Chongqing Medical University, 55 University-Town Middle Road, Shapingba District, Chongqing, China.
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Greco M, Calgaro G, Cecconi M. Management of hospital admission, patient information and education, and immediate preoperative care. Saudi J Anaesth 2023; 17:517-522. [PMID: 37779563 PMCID: PMC10540991 DOI: 10.4103/sja.sja_592_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/03/2023] Open
Abstract
An increasing proportion of surgical procedures involves elderly and frail patients in high-income countries, leading to an increased risk of postoperative complications. Complications significantly impact patient outcomes and costs, due to prolonged hospitalization and loss of autonomy. Consequently, it is crucial to evaluate preoperative functional status in older patients, to tailor the perioperative plan, and evaluate risks. The hospital environment often exacerbates cognitive impairments in elderly and frail patients, also increasing the risk of infection, falls, and malnutrition. Thus, it is essential to work on dedicated pathways to reduce hospital readmissions and favor discharges to a familiar environment. In this context, the use of wearable devices and telehealth has been promising. Telemedicine can be used for preoperative evaluations and to allow earlier discharges with continuous monitoring. Wearable devices can track patient vitals both preoperatively and postoperatively. Preoperative education of patient and caregivers can improve postoperative outcomes and is favored by technology-based approach that increases flexibility and reduce the need for in-person clinical visits and associated travel; moreover, such approaches empower patients with a greater understanding of possible risks, moving toward shared decision-making principles. Finally, caregivers play an integral role in patient improvement, for example, in the prevention of delirium. Hence, their inclusion in the care process is not only advantageous but essential to improve perioperative outcomes in this population.
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Affiliation(s)
- Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giulio Calgaro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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Capoglu R, Alemdar M, Bayhan Z, Gonullu E, Akın E, Altintoprak F, Harmantepe AT, Kucuk F, Demir H, Aka BU. Effects of cognitive status on outcomes of groin hernia repair using various anesthesia techniques. Hernia 2023; 27:1315-1323. [PMID: 36449177 DOI: 10.1007/s10029-022-02725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND AIM Because of increasing life expectancy, there is an increasing number of cognitively impaired older individuals undergoing surgeries such as groin hernia repair. Here, we evaluated the effects of cognitive status on postoperative complication rates in patients undergoing groin hernia repair using various anesthesia techniques. We also analyzed the rate of same-day hernia surgery in patients with cognitive decline. METHODS Patients who presented to our general surgery clinic for unilateral or bilateral inguinal or femoral hernia were prospectively classified into general (group 1), local (group 2), and spinal (group 3) anesthesia groups. The Mini-Mental State Examination (MMSE) was used for preoperative evaluation of each patient's cognitive status. The Visual Analog Scale (VAS) was used to evaluate postoperative pain. Groups were compared in terms of age, MMSE and VAS scores, cognitive decline and complication rates, and surgery duration. RESULTS In total, 33 (35.1%), 30 (31.9%), and 31 (33.0%) of 94 patients underwent surgery using general, local, and spinal anesthesia, respectively. The mean MMSE score did not differ among groups (p = 0.518). Cognitive decline was present in 18 (19.2%) patients, and the proportion did not significantly differ among groups. The complication rate did not differ between patients with and without cognitive decline. The mean surgery duration was similar among the three groups (p = 0.127). Group 2 had a lower mean postoperative VAS score, compared with the other groups (p < 0.001). Complications because of anesthesia and surgery were significantly more common in group 3 than in the other groups (p = 0.025). In the local anesthesia group, 7 patients had cognitive decline and 22 patients had normal cognition. There were no significant differences between patients with and without cognitive decline in terms of mean surgery duration (50.3 ± 15.4 min vs. 45.2 ± 10.7 min; p = 0.338) or mean VAS score (3.14 ± 0.90 vs. 3.13 ± 0.77; p = 0.985). Among the 22 and 7 patients without and with cognitive decline, 11 (50%) and 0 patients were discharged on the same day (p = 0.025). In the local anesthesia group, the respective median ages were 70, 52, and 59 years for patients with cognitive decline, patients with normal cognition discharged on the same day, and patients with normal cognition who were not discharged on the same day (p = 0.001). CONCLUSION Groin hernia repair was successfully performed under local anesthesia in all patients, including older patients with cognitive decline. Patients with cognitive decline were not discharged on the day of surgery, although the mean surgery duration and postoperative VAS score did not differ between patients with and without cognitive decline. Prolonged hospitalization in patients with cognitive decline may be related to their advanced age. Further studies are needed to determine the safety of same-day surgery in patients with cognitive decline.
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Affiliation(s)
- Recayi Capoglu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Murat Alemdar
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey.
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
- Department of Gastrointestinal Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Emrah Akın
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Furkan Kucuk
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Hakan Demir
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Bahaeddin Umur Aka
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Álvarez-Aguilera M, DeJesús-Gil Á, Sánchez-Arteaga A, Tinoco-González J, Suárez-Grau JM, Tallón-Aguilar L, Padillo-Ruiz J. Implementing an outpatient surgical management in moderated-high risk patients with groin hernia repair. Hernia 2023; 27:1307-1313. [PMID: 37261641 DOI: 10.1007/s10029-023-02813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE There is a growing trend to expand Ambulatory Surgery (AS) criteria in abdominal wall surgery. No Admission (NOADS) circuit. The present study aimed to assess the impact of classification criteria on postoperative results and hospital stays in a NOADS versus a conventional admission circuit to throw some light on surgical circuit inclusion. METHODS A retrospective analysis of a prospective;y maintained database was performed comparing groin hernia's interventions in a NOADS vs Admission circuit in our center in 2018-2021. A multiple regression predictive model followed by a retrospective retest were dessigned to assess the impact of each criterion on hospital stay. In total, 743 patients were included, 399 in the Admission circuit (ADC) and 344 in NOADS circuit (NOADS). RESULTS There were no statistical differences in complication or readmission rates (p = 0.343 and p = 0.563), nevertheless, a shorter hospital stay was observed in NOADS (p = 0.000). A hierarchical multiple regression predictive model proposed two opposite scenarios. The best scenario, not likely to need admission, was a female patient operated via the laparoscopic approach of a unilateral primary hernia (Estimated Postoperative Stay: 0.049 days). The worst scenario, likely to need admission, was a male patient operated via the open approach of a bilateral and recurrent hernia (Estimated Postoperative Stay: 1.505 Days). CONCLUSION Groin hernia patients could safely benefit from a No Admission (NOADS) circuit. Our model could be useful for surgical circuit decision-making, especially for best/worst scenarios.
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Affiliation(s)
- M Álvarez-Aguilera
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - Á DeJesús-Gil
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - A Sánchez-Arteaga
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - J Tinoco-González
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - J M Suárez-Grau
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
| | - L Tallón-Aguilar
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain.
| | - J Padillo-Ruiz
- Ambulatory Surgery-Abdominal Wall Reconstruction Unit, Department of Surgery, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot S/N, 41013, Seville, Spain
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Davis S, Mills JMZ, Edwards S, Hugh TJ. Persistent low rates of same-day umbilical hernia repair in Australia over the past 20 years: is there a need to change? ANZ J Surg 2022; 92:2511-2516. [PMID: 35437895 DOI: 10.1111/ans.17719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/26/2022] [Accepted: 04/02/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several recent reports have identified significant variations in discharge practices following umbilical hernia repair (UHR). The primary aim of this paper is to determine Australian UHR same day discharge (SDD) rates over the past two decades. Secondary aims are to analyse factors which may contribute to variation in discharge practices, compare Australian UHR SDD rates internationally and determine LOS trends. METHODS A retrospective, population-based cohort study was conducted using de-identified data from the Australian Institute of Health and Welfare (1 July 1998 to 30 June 2019). SDD rates and LOS were calculated for age, gender and complexity. Negative binomial models were used to investigate associations between characteristics. RESULTS The overall mean UHR SDD rate was 41.2% with a modest improvement over the study period (36.5% to 44.4%, P < 0.0001). The mean LOS was 3.4 days, and this decreased over the study period (P = 0.01). Males had a higher rate of SDD (42.1% vs. 39.4%, P < 0.0001) and shorter LOS (3.0 vs. 3.7 days, P < 0.0001) compared with females. Increased age was associated with decreased SDD (P < 0.0001) and increased LOS (P < 0.0001). Australia's SDD rate was lower than in both New Zealand and the United Kingdom. CONCLUSION While SDD and LOS following UHR improved across the study period, SDD rates remain below the RACS recommendation and compare unfavourably internationally. Advancing age and female gender were associated with decreased SDD and increased LOS demonstrating potential areas for improvement. Multiple strategies are discussed to address the persistently low rates of SDD after UHR.
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Affiliation(s)
- Sean Davis
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Adelaide Medical School, Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Joanna M Z Mills
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, South Australia, Australia
| | - Thomas J Hugh
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Perez AJ, Campbell S. Inguinal Hernia Repair in Older Persons. J Am Med Dir Assoc 2022; 23:563-567. [DOI: 10.1016/j.jamda.2022.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
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Subcutaneous fat area as a risk factor for extraction site incisional hernia following gastrectomy for gastric cancer. Surg Today 2020; 50:1418-1426. [PMID: 32488478 DOI: 10.1007/s00595-020-02039-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/26/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To identify the incidence of extraction site incisional hernia following gastrectomy for gastric cancer and its significant risk factors, including the subcutaneous fat area. METHODS We reviewed data gathered prospectively on patients with gastric cancer, who underwent gastrectomy between 2008 and 2012 at Kyushu University Hospital, Fukuoka, Japan. The subcutaneous fat area (SFA) and visceral fat area (VFA) were measured using axial computed tomography at the level of the L4 and L3 transverse processes, and the L2-L3 intervertebral disc. The primary endpoint of the rate of extraction site incisional hernia was based on the computed tomography and clinical data including hospital follow-up reports. RESULTS After applying the inclusion and exclusion criteria, 320 patients were included in this retrospective analysis: 3.1% (10/320) had extraction site incisional hernias after a mean follow-up of 11 months. Multivariate analysis revealed that age and the SFA were independent risk factors (age ≥ 70.5 years: P = .013, odds ratio: 9.116, 95% confidence interval 1.581-52.553; L4 SFA ≥ 124 cm2: P = .004, odds ratio: 13.752, 95% confidence interval 2.290-82.582). CONCLUSION Age and the SFA were independent risk factors for extraction site incisional hernia in patients undergoing gastrectomy for gastric cancer.
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Docimo S, Bates A, Alteri M, Talamini M, Pryor A, Spaniolas K. Evaluation of the use of component separation in elderly patients: results of a large cohort study with 30-day follow-up. Hernia 2020; 24:503-507. [PMID: 31894430 DOI: 10.1007/s10029-019-02069-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 10/11/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND The incidence of massive ventral hernias among the elderly will increase as the population ages. Advanced age is often viewed as a contraindication to elective hernia repair. A relationship between age and complications of component separation procedures for ventral hernias is not well established. This study evaluated the effect of age on the peri-operative safety of AWR. METHODS The 2005-2013 ACS-NSQIP participant use data were reviewed to compare surgical site infection (SSI), overall morbidity, and serious morbidity in non-emergent component separation procedures among all age groups. All patients were stratified into four age quartiles and evaluated. Baseline characteristics included age, body mass index (BMI) and ASA 3 or 4 criteria. Statistical analysis was performed using SPSS. Odds ratios (OR) and 95% confidence intervals were reported as appropriate. RESULTS 4485 patients were identified. Majority of the cases were clean (76.8%). Patients were divided into the following quartiles based on age. The older quartile had a mean age of 72.7 ± 4.87 years. There were baseline differences in BMI and chronic comorbidity severity (measured by incidence of ASA score of 3 or 4) between the age groups, with the oldest group having lower BMI but higher rate of ASA 3 or 4 (p < 0.0001 for both). The rate of postoperative SSI was significantly different between age quartile groups (ranging from 16.3% from the youngest group to 9.4% for the oldest group, p < 0.0001). After adjusting for other baseline differences, advanced age was independently associated with lower SSI rate (OR 0.55, 95% CI 0.41-0.73). There was no significant difference in overall morbidity (p = 0.277) and serious morbidity (p = 0.131) between groups. CONCLUSION AWR is being performed with safety across all age groups. In selected patients of advanced age, AWR can be performed with similar safety profile and low SSI rate.
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Affiliation(s)
- S Docimo
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA.
| | - A Bates
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - M Alteri
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - M Talamini
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - A Pryor
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - K Spaniolas
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
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Seib CD, Rochefort H, Chomsky-Higgins K, Gosnell JE, Suh I, Shen WT, Duh QY, Finlayson E. Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations. JAMA Surg 2019; 153:160-168. [PMID: 29049457 DOI: 10.1001/jamasurg.2017.4007] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Frailty is a measure of decreased physiological reserve that is associated with morbidity and mortality in major elective and emergency general surgery operations, independent of chronological age. To date, the association of frailty with outcomes in ambulatory general surgery has not been established. Objective To determine the association between frailty and perioperative morbidity in patients undergoing ambulatory general surgery operations. Design, Setting, and Participants A retrospective cohort study was conducted of 140 828 patients older than 40 years of age from the 2007-2010 American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent ambulatory and 23-hour-stay hernia, breast, thyroid, or parathyroid surgery. Data analysis was performed from August 18, 2016, to June 21, 2017. Main Outcomes and Measures The association between the National Surgical Quality Improvement Program modified frailty index and perioperative morbidity was determined via multivariable logistic regression with random-effects modeling to control for clustering within Current Procedural Terminology codes. Results A total of 140 828 patients (80 147 women and 60 681 men; mean [SD] age, 59.3 [12.0] years) underwent ambulatory hernia (n = 71 455), breast (n = 51 267), thyroid, or parathyroid surgery (n = 18 106). Of these patients, 2457 (1.7%) experienced any type of perioperative complication and 971 (0.7%) experienced serious perioperative complications. An increasing modified frailty index was associated with a stepwise increase in the incidence of complications. In multivariable analysis adjusting for age, sex, race/ethnicity, anesthesia type, tobacco use, renal failure, corticosteroid use, and clustering by Current Procedural Terminology codes, an intermediate modified frailty index score (0.18-0.35, corresponding to 2-3 frailty traits) was associated with statistically significant odds ratios of 1.70 (95% CI, 1.54-1.88; P < .001) for any complication and 2.00 (95% CI, 1.72-2.34; P < .001) for serious complications. A high modified frailty index score (≥0.36, corresponding to ≥4 frailty traits) was associated with statistically significant odds ratios of 3.35 (95% CI, 2.52-4.46; P < .001) for any complication and 3.95 (95% CI, 2.65-5.87; P < .001) for serious complications. Anesthesia with local and monitored anesthesia care was the only modifiable covariate associated with decreased odds of serious 30-day complications, with an adjusted odds ratio of 0.66 (95% CI, 0.53-0.81; P < .001). Conclusions and Relevance Frailty is associated with increased perioperative morbidity in common ambulatory general surgery operations, independent of age, type of anesthesia, and other comorbidities. Surgeons should consider frailty rather than chronological age when counseling and selecting patients for elective ambulatory surgery.
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Affiliation(s)
- Carolyn D Seib
- Department of Surgery, University of California, San Francisco
| | - Holly Rochefort
- Department of Surgery, University of California, San Francisco
| | | | | | - Insoo Suh
- Department of Surgery, University of California, San Francisco
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco
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Outpatient groin hernia repair: assessment of 9330 patients from the French "Club Hernie" database. Hernia 2017; 22:427-435. [PMID: 29080110 DOI: 10.1007/s10029-017-1689-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Groin hernia repair (GHR) is one of the most frequent surgical interventions practiced worldwide. Outpatient surgery for GHR is known to be safe and effective. AIM To assess the outpatient practice for GHR in France and identify predictive factors of failure. METHOD Forty one surgeons of the French "Club Hernie" prospectively gathered data concerning successive GHR over a period of 4 years within a multicenter database. RESULTS A total of 9330 patients were operated on during the period of the study. Mean age was 61.8 (1-100) years old and 8245 patients (88.4%) were males. 6974 GHR (74.7%) were performed as outpatient procedures. In 262 patients (3.6%), the outpatient setting, previously selected, did not succeed. Upon multivariate analysis, predictive factors of ambulatory failure were ASA grade ≥ III (OR 0.42, p < 0.001), bilateral GHR (OR 0.47, p < 0.001), emergency surgery for incarcerated hernia (OR 0.10, p < 0.001), spinal anesthesia (OR 0.27, p < 0.001) and occurrence of an early post-operative complication (OR 0.07, p < 0.001). The more frequent complications were acute urinary retention and surgical site collections. 2094 patients (21.5%) were not selected preoperatively for 1-day surgery. CONCLUSION More than 74% of the patients benefited from outpatient surgery for GHR with a poor failure rate. Predictive factors of outpatient GHR failure were ASA grade ≥ III, bilateral GHR, emergency surgery for incarcerated hernia, spinal anesthesia and occurrence of an early post-operative complication. Ambulatory failures were often related to social issues or medical complications. Outpatient surgery criteria could become less restrictive in the future.
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Romano G, Calò PG, Erdas E, Medas F, Gordini L, Podda F, Amato G. Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant. Aging Clin Exp Res 2017; 29:173-177. [PMID: 27837460 DOI: 10.1007/s40520-016-0651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair. AIMS In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith. METHODS A tentacle-shaped flat mesh with a large central body and integrated arms was used to repair incisional hernia in 23 elderly patients. The mesh was placed fixation-free and secured in place through the friction exerted by the tentacles. All tentacle straps were positioned with a special passer needle. Implant placement was preperitoneal in 18 patients and retromuscular sublay in five. RESULTS In a follow-up of 18 to 59 months (mean 36 months), four seromas occurred. Postoperative fast track helped avoid the typical complications affecting this patient subset. No infection, hematoma, chronic pain, mesh dislocation or recurrence have been reported to date. DISCUSSION The tentacle strap system allowed for reduced skin incision thus minimizing surgical trauma and ensuring easier and faster implant placement. CONCLUSION The tentacle arms of the implant ensured mesh stability and broad defect overlap. Besides a very low complication rate, none of the typical postoperative complications of aged patients occurred.
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Affiliation(s)
- Giorgio Romano
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Pier Giorgio Calò
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Enrico Erdas
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Fabio Medas
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Luca Gordini
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Francesco Podda
- Department of General Surgery, University of Cagliari, Cagliari, Italy
| | - Giuseppe Amato
- Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy.
- , via M. Rapisardi 66, 90144, Palermo, Italy.
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Combined inguinal hernia in the elderly. Portraying the progression of hernia disease. Int J Surg 2016; 33 Suppl 1:S20-9. [DOI: 10.1016/j.ijsu.2016.05.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ferrarese A, Enrico S, Solej M, Surace A, Nardi MJ, Millo P, Allieta R, Feleppa C, D'Ambra L, Berti S, Gelarda E, Borghi F, Pozzo G, Marino B, Marchigiano E, Cumbo P, Bellomo MP, Filippa C, Depaolis P, Nano M, Martino V. Laparoscopic management of non-midline incisional hernia: A multicentric study. Int J Surg 2016; 33 Suppl 1:S108-13. [PMID: 27353846 DOI: 10.1016/j.ijsu.2016.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The laparoscopic repair of non-midline ventral hernia (LNM) has been debated. The aim of this study is to analyze our experience performing the laparoscopic approach to non-midline ventral hernias (NMVHs) in Northwest Italy for 6 years. METHODS A total of 78 patients who underwent LNM between March 2008 and March 2014 in the selected institutions were analyzed. We retrospectively analyzed the peri- and postoperative data and the recurrence rate of four subgroups of NMVHs: subcostal, suprapubic, lumbar, and epigastric. We also conducted a literature review. RESULTS No difference was found between the four subgroups in terms of demographic data, defect characteristics, admission data, and complications. Subcostal defects required a shorter operating time. Obesity was found to be a risk factor for recurrence. CONCLUSIONS In our experience, subcostal defects were easier to perform, with a lower recurrence rate, lesser chronic pain, and faster surgical performance. A more specific prospective randomized trial with a larger sample is awaited. Based on our experience, however, the laparoscopic approach is a safe treatment for NMVHs in specialized centers.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | | | - Paolo Millo
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Rosaldo Allieta
- Hospital "Umberto Parini", Section of General Surgery, Aosta, Italy.
| | - Cosimo Feleppa
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Luigi D'Ambra
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Stefano Berti
- Hospital "Sant'Andrea", Section of General Surgery, La Spezia, Italy.
| | - Enrico Gelarda
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Felice Borghi
- Hospital "Santa Croce e Carle", Section of General Surgery, Cuneo, Italy.
| | - Gabriele Pozzo
- Hospital "Civile", Section of General Surgery, Asti, Italy.
| | | | - Emma Marchigiano
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | - Pietro Cumbo
- Hospital "Santa Croce", Section of General Surgery, Moncalieri, Italy.
| | | | - Claudio Filippa
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Paolo Depaolis
- Hospital "Gradenigo", Section of General Surgery, Torino, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Torino, Italy.
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Hotchen AJ, Coleman G, O'Callaghan JM, McWhinnie D. Safe and sustainable increases in day case emergency surgery. Br J Hosp Med (Lond) 2016; 77:180-3. [DOI: 10.12968/hmed.2016.77.3.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew J Hotchen
- Foundation Doctor in the Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes
| | - Grant Coleman
- Foundation Doctor in the Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes
| | - John M O'Callaghan
- Surgical Registrar in the Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes
| | - Doug McWhinnie
- Surgical Consultant in the Department of Surgery, Milton Keynes Hospital, Milton Keynes MK6 5LD
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Caglià P, Tracia A, Borzì L, Amodeo L, Tracia L, Veroux M, Amodeo C. Incisional hernia in the elderly: Risk factors and clinical considerations. Int J Surg 2014; 12 Suppl 2:S164-S169. [DOI: 10.1016/j.ijsu.2014.08.357] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/03/2023]
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Ferrarese A, Marola S, Surace A, Borello A, Bindi M, Cumbo J, Solej M, Enrico S, Nano M, Martino V. Fibrin glue versus stapler fixation in laparoscopic transabdominal inguinal hernia repair: a single center 5-year experience and analysis of the results in the elderly. Int J Surg 2014; 12 Suppl 2:S94-S98. [PMID: 25183643 DOI: 10.1016/j.ijsu.2014.08.371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Inguinal hernia surgery is one of the most common surgical procedures performed worldwide. Some studies demonstrated clear advantages of laparoscopic approach in terms of chronic pain, recurrence rate and daily life activities Aim of this study was to compare short and long-terms outcome of tacks and fibrin glue used during laparoscopic transabdominal hernioplasty (TAPP). METHODS This is a retrospective study conducted by our division of General Surgery. From May 2008 to May 2013 we performed 116 hernioplasty with TAPP technique. We compared two groups of patients: a group of 59 patients treated with fibrin glue and a group of 57 patients treated with conventional tacks and the two subgroups of patients over 65 years old. We evaluated: perioperative outcomes, early and late complications. RESULTS There were no significative difference about length of postoperative stay, time to return to work, recurrence rate and complications. DISCUSSION This study demonstrates that fibrin glue are same tolerated than tacks by patients and that the glues lead to the same good results during initial follow-up and in long term data also in the elderly. Meticulous preparation of the groin with preservation of spermatic sheet is in our opinion necessary to provide effective pain reduction and a good result in every TAPP procedure.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Silvia Marola
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Alessandro Borello
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Jacopo Cumbo
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
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