Department of Surgery, Washington University, St. Louis, MO.
Department of Surgery, Washington University, St. Louis, MO.
Surgery. 2023 Mar;173(3):732-738. doi: 10.1016/j.surg.2022.07.043. Epub 2022 Oct 21.
Although ventral hernias are common in older adults and can impair quality of life, multiple barriers exist that preclude ventral hernia repair. The goal of this study was to determine if older adults with ventral hernias achieve surgeon-directed goals to progress to an elective ventral hernia repair.
Patients ≥60 years evaluated for a ventral hernia in a specialty clinic from January 2018 to August 2021 were retrospectively reviewed. Nonoperative candidates with modifiable risk factors were included. Data collected included specific barriers to ventral hernia repair and recommendations to address these barriers for future ventral hernia repair eligibility. Patients lost to follow-up were contacted by phone.
In total, 559 patients were evaluated, with 182 (32.6%) deemed nonoperative candidates with modifiable risk factors (median age 68 years, body mass index 38.2). Surgeon-directed recommendations included weight loss (53.8%), comorbidity management by a medical specialist (44.0%), and smoking cessation (19.2%). Ultimately, 45/182 patients (24.7%) met preoperative goals and progressed to elective ventral hernia repair. Alternatively, 5 patients (2.7%) required urgent/emergency surgical intervention. Importantly, 106/182 patients (58.2%) did not return to clinic after initial consultation. Of those contacted (n = 62), 35.5% reported failure to achieve optimization goals. Initial body mass index ≥40 and surgeon-recommended weight loss were associated with lack of patient follow-up (P = .01, P = .02) and progression to elective ventral hernia repair (P = .009, P = .005).
Nearly one-third of older adults evaluated for ventral hernias were nonoperative candidates, most often due to obesity, and over half of these patients were lost to follow-up. An increase in structured support is needed for patients to achieve surgeon-specified preoperative goals.
尽管老年人中常见腹疝，且会降低生活质量，但存在多种障碍会妨碍腹疝修复。本研究旨在确定患有腹疝的老年人是否能够达到外科医生指导的目标，以进行择期腹疝修复。
回顾性分析 2018 年 1 月至 2021 年 8 月在专门诊所评估腹疝的≥60 岁患者。纳入有可纠正风险因素的非手术候选者。收集的数据包括腹疝修复的具体障碍以及为未来腹疝修复资格解决这些障碍的建议。对失去随访的患者通过电话联系。
共评估了 559 例患者，其中 182 例（32.6%）被认为是有可纠正风险因素的非手术候选者（中位年龄 68 岁，体重指数 38.2）。外科医生指导的建议包括减肥（53.8%）、由医学专家管理合并症（44.0%）和戒烟（19.2%）。最终，45/182 例患者（24.7%）达到术前目标并进行择期腹疝修复。另外，5 例患者（2.7%）需要紧急/急诊手术干预。重要的是，182 例患者中有 106/182 例（58.2%）在初次就诊后未返回诊所。在联系的患者中（n=62），35.5%报告未能达到优化目标。初始体重指数≥40 和外科医生建议减肥与患者随访不良（P=0.01，P=0.02）和择期腹疝修复进展（P=0.009，P=0.005）相关。
评估腹疝的老年人中有近三分之一为非手术候选者，最常见的原因是肥胖，其中超过一半的患者失去随访。需要增加结构化支持，以帮助患者达到外科医生规定的术前目标。
