Is elective hernia repair worthwhile in old patients?

Abstract

Objective: To find out if elective hemiorraphy in patients aged 75 and over is worthwhile. Design: Retrospective study. Setting: District hospital, Sweden. Subjects: 146 consecutive patients aged 75 years or more, who had their hernias repaired during the period 1992-95. Main outcome measures: Patient satisfaction measured by a five-point analogue scale. Clinical and personal details; morbidity, mortality, and surgical variables were obtained from case records. Results: Community social service was not required by 114 (78%) of the patients and 15 (22%) had no preoperative complaints. Our patients rated their satisfaction with their choice to have an operation, as well as its effect on their preoperative symptoms as 4.9. Emergency operations (p = 0.02), femoral hernias (p = 0.01) and direct inguinal hernias (direct:indirect ratio 0.81) were more common in this age group. Femoral and direct inguinal hernias tended to recur more often than usual. Emergency operation, dementia, and diabetes were associated with a reduced short-term survival. Conclusion: Elective hernia repair in an elderly population is highly appreciated by the patients, and worthwhile. If coexisting disease and domestic arrangements are controlled, the patients' need for hospital care can be minimised. Mesh is recommended in femoral and direct inguinal hernias, which were associated with an increased reoperation frequency. A more vigilant protocol of indications for hernia surgery in the aged may minimise the need for both emergency and unnecessary operations.