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Inguinal and femoral hernia repair in octogenarians and nonagenarians - A population based analysis
J. Pina-Vaz, Basel
Thursday, May 17, 2018 · 10:37 a.m. · 06m 38s
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morning everyone of us allies of the members of the panel thank you very much
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for the opportunity to be here to present our study the population data analysis
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on the outcomes of being unknown femoral hernia repair in the elderly population i've got
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which i which one of you is not familiar with the scenario we sit in our office with the
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door comes eighty five year old patients yes there is something in my current it's hard to beat
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doesn't stop me from my daily activities but my doctor said it could turn into
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something dangerous and i should conceive surgeon are you going to break me
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are you other um surgeons i've been thinking about this and tried to answer
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it some define the elderly as people over sixty five years of age
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then it up concluding that the cut off should be probably higher because there
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is a difference between sixty five or older an eighty year old nowadays
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others only focused on in this gothic treatments others only said this uh so
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what happen in electing setting the ones that cover a lot topics
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ended up having smaller samples which makes the representative eighty of
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the elderly not so significant we try to take off mondays and
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design also study that represents what is happening in switzerland
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this would be our main question is there a difference in post operative mortality between the three age groups
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we defy the divided the elderly between oxygen areas
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and on the generic and excluded the children
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gather data between two thousand five in two thousand sixteen from this may be seen
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the statistic the condom highs that which gathers data from all hospitals in switzerland
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only the allstate allies patients for all like no this medical or surgical
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we extracted the patients that and awaiting the no informal hernia repair ended
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up with a sample of one hundred eighty seven thousand patients
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we had a male predominance we had morning we know any as we
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have more femoral than using the females these are no surprises
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that he in hospital mortality of these um population
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was relatively low zero point fifteen percent if
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we check the differences between the age groups in the younger population it's much lower
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in the oxygen variance it reaches one percent and in the non engineering and it
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almost goes to four percent which makes it rather than to for this patient
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we also wanted to know if there would be a difference in our outcomes depending on the surgical approach
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and the type of hernia if you was a recurrence or a primary
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hernia if we're talking about an elective surgery or we art
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emergency thirteen and if there was a need to perform the bowery section additionally to the hernia repair
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the electives cases war ninety four percent the rest or emergencies
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from our entire population throughout this eleven years only
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four hundred forty patients needed a power section
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um but eighty percent of these restrictions were performed in an emergency setting
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the in hospital mortality in the electives cases e. zero point zero three percent
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which would make this a it's actually it's safe procedure at least if you perform it in switzerland
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but the difference is between age groups it goes higher in the elderly but with a steel
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input numbers still under one percent when we compare these with emergency setting this situation changes
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drastically especially for the elderly reaching four point five percent for the oxygen
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areas and almost doubling to eight percent in the knowledge in areas
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and here i am tempted to look at this date angle back to my patients
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in my office and say yes i want to operate to you and it's
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uh and and and not wait until you come into the emergency department with incarceration
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but can i really just base myself on this data and answer this question
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so that's why we are trying to also see what happens um
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uh what are the other differences in our outcomes when you look at the l. status of this
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patient before surgery and we are defining three operative morbidity based on our since you escort
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and still conducting um we'll do variable analysis uh to to try to see how this affects our outcome
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this data is not ready yet unfortunately so we have to wait for second that is what
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down in hospital mortality when we perform the bowery section was
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higher with seven point three percent for the total population
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but when we look at the the values in the elderly it's the
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really big difference reaching almost twenty five percent in the knowledge marion
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and keeping in mind that eighty percent of these restrictions happened
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in an emergency emergency setting i had this question
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could be if the bowery section be a factor contributing to the
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high mortality rate in an emergency operation it's just a question
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about how our patients recover after surgery we define post operative morbidity has
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the surgical related complications and excluded the non surgical related complications
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as you can see you much all my is one of the most frequent it doesn't have that high frequency in the general population
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to check with the what happens in the elderly it almost three four times higher
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we can find very good medical reasons for that also the same we can see in the urinary retention is
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almost doubled in this kind of patients but they're still
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complications that are easily treated with conservative majors
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there's still a lot that i would like to know sadly i don't have enough data for that because i would like to
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know what is the quality of life of these patients after surgery
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what happens with the internal the chronicle pain seems wrong
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i also don't have data about the surgeries performed in outpatient setting that is becoming more frequent
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and i don't have information about the patient that went to the doctor had the diagnosis but
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somehow an elective procedure was rejected either the surgeon they don't want to recommend it
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or the patient was afraid uh of the surgery accordingly physiologist use this
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criteria to describe this patient as high risk or um i inoperable
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so just to finish and probably over my time um we
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saw a low in hospital mortality in post operative mobility
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in the elderly in electives cases the situation isn't much
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different in an emergency setting with high mortality rate
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and these could probably be related to the need for
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