Safety and feasibility of same-day-surgery inguinal hernia repair in patients aged ≥70 Years: A propensity score-matched study.

INTRODUCTION

Inguinal hernia repair is becoming increasingly popular as a same-day surgery (admission, operation, and discharge within 24 h) as the proportion of elderly people increases. Relevant studies have not been completed; therefore, our objective was to evaluate the safety and feasibility of same-day surgery modalities for inguinal hernia repair in elderly patients aged 70 years and older.

METHODS

We conducted a retrospective analysis of patients who underwent inguinal hernia repair at our institution between January 2020 and December 2023. Patients were categorized into three groups: a same-day surgery group aged ≥70 years, an inpatient group aged ≥70 years, and a same-day surgery group aged <70 years. Using 1:1 propensity score matching (PSM), the ≥70 years same-day surgery group was compared separately with the ≥70 years inpatient group and the <70 years same-day surgery group. Postoperative outcomes were compared between these matched cohorts.

RESULTS

The study included 230 patients ≥70 years in the same-day surgery group, 645 patients ≥70 years in the inpatient group, and 570 patients <70 years in the same-day surgery group before matching. After PSM, 230 matched pairs were formed for the comparison between the ≥70 years same-day surgery and inpatient groups. No significant differences were found in intraoperative blood loss, operative time, or postoperative complications (including fever, vomiting, urinary retention, VTE, seroma, wound healing, pain scores at discharge, and recurrence rates) (P > 0.05). However, relative to same-day surgery, inpatient management was associated with significantly higher total costs (¥15,006.84 ± 3045.87 vs. ¥12,990.42 ± 3399.61; P < 0.001) and a longer postoperative stay (40.35 ± 19.43 vs. 12.57 ± 3.74 h; P < 0.001). Another PSM created 156 matched pairs for the comparison between the ≥70 years and <70 years same-day surgery groups. Similarly, no significant differences were observed in all intraoperative and postoperative outcomes, including costs and complications (P > 0.05).

CONCLUSION

This propensity score-matched retrospective study demonstrates that day-surgery inguinal hernia repair is a safe and feasible option for carefully selected patients aged 70 years and older. This approach is suitable for those who are adequately assessed for anesthetic risk and have underlying medical conditions that do not require complex multidisciplinary care. The outcomes and cost-efficiency are comparable to both inpatient management in the elderly and same-day surgery in younger patients.