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Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

2020; Springer Science+Business Media; Volume: 26; Issue: 1 Linguagem: Inglês

10.1007/s10029-020-02269-5

1265-4906

Marco Ceresoli, Francesca Carissimi, Alice Nigro, Pietro Fransvea, L Lepre, Marco Braga, Gianluca Costa, Ferdinando Agresta, Giovanni Alemanno, Gabriele Anania, Massimo Antropoli, Giulio Argenio, Jenny Atzeni, Nicola Avenia, Antonio Azzinnaro, G. Baldazzi, Genoveffa Balducci, Giorgio Barbera, Giovanni Bellanova, Carlo Bergamini, Laura Bersigotti, Paolo Pietro Bianchi, Cristina Bombardini, Giuseppe Borzellino, Samantha Bozzo, Gioia Brachini, G. M. Buonanno, Tiberio Canini, S. Cardella, Giulia Carrara, Diletta Cassini, Maurizio Castriconi, Graziano Ceccarelli, D Celi, Marco Ceresoli, Marco Chiappetta, Massimo Chiarugi, Nicola Cillara, F Cimino, Luigi Cobuccio, Gianfranco Cocorullo, Ettore Colangelo, Gianluca Costa, Antonio Crucitti, P. DallaCaneva, Mónica Di Luca, A De Manzoni Garberini, Carlo De Nisco, Marco De Prizio, A. De Sol, Annamaria Di Bella, T. Falcioni, Nicolò Falco, Claudio Farina, Elena Finotti, Tommaso Fontana, Gianfranco Francioni, Pietro Fransvea, Barbara Frezza, Giovanni Maria Garbarino, Gianluca Garulli, Michele Genna, Sandro Giannessi, A. Gioffrè, Alessio Giordano, Débora Gozzo, Simone Di Maria Grimaldi, Gaspare Gulotta, V. Iacopini, T Iarussi, Giovanni Guglielmo Laracca, E. Laterza, A. Leonardi, L Lepre, Laura Lorenzon, Gianluigi Luridiana, A. Malagnino, G. Mar, Pierluigi Marini, Rinaldo Marzaioli, G. Massa, Valerio Mecarelli, Paolo Mercantini, Andrea Mingoli, Giuseppe Nigri, Savino Occhionorelli, Nadiane Paderno, Gian Marco Palini, D. Paradies, Marino Paroli, Fabrizio Perrone, Niccolò Petrucciani, Luca Petruzzelli, Angela Pezzolla, Diego Piazza, V. Piazza, Micaela Piccoli, Adolfo Pisanu, Mauro Podda, Gaetano Poillucci, Raffaele Porfidia, G. Rossi, Paolo Ruscelli, Alessandra Spagnoli, R. Sulis, Dario Tartaglia, Cristian Tranà, Antonio Travaglino, Pasquina M. C. Tomaiuolo, Andrea Valeri, Giorgio Vasquez, Márcia María Fontão Zago, E. Zanoni,

Hip and Femur Fractures

Abstract Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation