Comparison of the Outcomes of Watchful Waiting and Surgery in 80 Years of Age and Older Comorbid and Minimally Symptomatic Inguinal Hernia Patients

Abstract

Introduction: With the growing proportion of elderly people in the population, surgeons are dealing with more frail patients. In addition, the prevalence of inguinal hernia increases with age. We aimed to compare the outcomes of watchful waiting and surgery in inguinal hernia patients who were 80 years of age and older had comorbidities and were minimally symptomatic. Materials and Method: Two high volume, mostly comorbid patient treating tertiary care education hospitals' databases were searched for inguinal hernia patients >= 80 years of age. One hundred and fifty four of the 324 patients treated between April 2010 and April 2014 were included in this study. Demographic characteristics, comorbidities and patient reported outcomes were recorded from the database and telephone calls. Results: Mean patient age was 83 +/- 2.8 years and median follow-up time was 15 months. At diagnosis, 17 (11%) patients chose surgery, 137 patients were observed; of these, 74 (54.1%) crossed over to surgery, 48 (64.8%) elective and 26 (33.2%) emergency. The emergent operation rate for observation group was 18.9%. Crossover was found to be corelated with emergency admission before the diagnosis, increased pain in admission, low American Society of Anesthesiologists score, bowel resection and complications. Four patients were died within 30-days postoperatively, three in emergent and one in elective crossover. Mortality was corelated with heart failure and bowel resection. Conclusion: Although recommending watchful waiting for 80 years of age and older inguinal hernia patients with comorbidities and minimal symptoms sounds logical, the natural course of these patients is intriuging. Planned herniorrhaphy under local anaesthesia for extremely old and comorbid patients seems more acceptable today.