Huerta S, Phung T, Tran N, Lanier H, Pham T
Department of Surgery, University of Texas Southwestern Medical Center, VA North Texas Health Care System, 4500 S. Lancaster Road (112), Dallas, TX, 75216, USA.
University of Texas Southwestern School of Medicine, Dallas, TX, USA.
Hernia. 2022 Feb;26(1):243-249. doi: 10.1007/s10029-021-02525-2. Epub 2021 Oct 22.
While elective inguinal hernia repair (IHR) in octogenarians carries a low 30-day mortality rate, long-term outcomes are uncharted. If on average, veteran octogenarians are expected to succumb to pre-existing cardiopulmonary disease within a year of diagnosis, watchful waiting might be advisable. This study interrogated long-term mortality and its predictors following elective IHR in veteran octogenarians.
This is a retrospective analysis of 109 veterans (≥ 80 years of age), ten of which were nonagenarians who had an elective IHR. Data were dichotomized between deceased vs. non-deceased patients for univariable and multivariable analyses. Patient characteristics were also assessed in patients undergoing general (GA) vs. local (LA) anesthesia and corrected for unilateral repair and age. Kaplan-Meier curves were generated in corrected and uncorrected cohorts receiving GA vs. LA.
At the time of analysis, 46 (45.0%) octogenarians were deceased. The average time to death following IHR was 3.7 ± 2.9 years [range (37 days-12.4 years)]. Univariable analysis showed renal disease (19.9% vs. 5.3%), operative time (67.9 ± 29.0 vs. 56.1 ± 14.4 min) and use of GA (73.0% vs. 34.8%) associated with long-term mortality (all p < 0.01). Renal disease [odds ratio (95% confidence intervals) 4.1 (1.2-13.8)] and use of GA [5.0 (2.0-10.0)] were independent predictors of mortality. Patients undergoing LA (n = 62) were older, were more likely to have cardiac disease, and had a higher ASA compared to patients receiving GA (n = 47). After correcting for age, cardiac disease and higher ASA remained more common in patients submitting to LA. Long-term mortality was significantly higher in both matched and unmatched octogenarians undergoing GA.
Octogenarian veterans with a high burden of comorbid conditions are unlikely to experience short-term mortality because of their pre-existing conditions. Inguinal hernia repair should be offered to octogenarian veterans, but GA should be avoided whenever possible.
虽然老年患者择期腹股沟疝修补术（IHR）的30天死亡率较低，但长期预后尚不清楚。如果平均而言，老年退伍军人预计在诊断后一年内死于已有的心肺疾病，那么观察等待可能是可取的。本研究探讨了老年退伍军人择期IHR后的长期死亡率及其预测因素。
这是一项对109名退伍军人（≥80岁）的回顾性分析，其中10名是接受择期IHR的非agenarians。数据在死亡患者与未死亡患者之间进行二分法分析，以进行单变量和多变量分析。还对接受全身麻醉（GA）与局部麻醉（LA）的患者的特征进行了评估，并对单侧修复和年龄进行了校正。在接受GA与LA的校正和未校正队列中生成Kaplan-Meier曲线。
在分析时，46名（45.0%）老年患者死亡。IHR后平均死亡时间为3.7±2.9年[范围（37天-12.4年）]。单变量分析显示，肾病（19.9%对5.3%）、手术时间（67.9±29.0对56.1±14.4分钟）和GA的使用（73.0%对34.8%）与长期死亡率相关（所有p<0.01）。肾病[比值比（95%置信区间）4.1（1.2-13.8）]和GA的使用[5.0（2.0-10.0）]是死亡率的独立预测因素。与接受GA（n=47）的患者相比，接受LA（n=62）的患者年龄更大，更有可能患有心脏病，且ASA更高。在校正年龄后，心脏病和较高的ASA在接受LA的患者中仍然更为常见。接受GA的匹配和未匹配老年患者的长期死亡率均显著更高。
患有高合并症负担的老年退伍军人不太可能因其已有的疾病而经历短期死亡。应向老年退伍军人提供腹股沟疝修补术，但应尽可能避免使用GA。
