Hernia : the journal of hernias and abdominal wall surgery · 2026
Frailty in a low-risk elective setting: a quality improvement study at Shouldice Hospital.
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Paasch Christoph, Svendrovski Anton, Usher Jennifer, Mainprize Marguerite
Аннотация
PURPOSE: This study aims to evaluate the impact of frailty on postoperative outcomes after Shouldice primary inguinal hernia Repair (SPIHR) as a quality control measure in a highly standardized elective setting.
METHODS: This quality improvement study analyzed data from an ongoing prospective PROM program including patients undergoing primary unilateral or bilateral Shouldice inguinal hernia Repair. Frailty was assessed using the 5-item modified Frailty Index (mFI-5). Postoperative complications were identified via 30-40-day questionnaires and clinically verified when reported. Outcomes were compared between frail and non-frail patients using univariate analyses and multivariable logistic regression adjusted for relevant covariates. Data analysis was performed between December 2025 and January 2026.
RESULTS: A total of 1,300 patients undergoing primary Shouldice inguinal hernia Repair were included (median age 64 years; 94.6% male). Overall, 29.7% of patients were classified as frail (mFI-5 ≥ 1). In univariate analyses, frail patients were older and had a higher body mass index and a greater comorbidity burden compared with non-frail patients. Frail patients also presented with larger hernia sizes for both first and second hernias. Postoperative complications were infrequent and did not differ significantly between frail and non-frail patients. In logistic regression analyses, frailty status was not independently associated with postoperative complications in either unadjusted or adjusted models.
CONCLUSION: Frailty was present in nearly one-third of patients undergoing Shouldice primary inguinal hernia Repair. Short-term postoperative complication rates were comparable between frail and non-frail patients, suggesting that primary Shouldice Repair is feasible in frail patients within a standardized elective setting.
METHODS: This quality improvement study analyzed data from an ongoing prospective PROM program including patients undergoing primary unilateral or bilateral Shouldice inguinal hernia Repair. Frailty was assessed using the 5-item modified Frailty Index (mFI-5). Postoperative complications were identified via 30-40-day questionnaires and clinically verified when reported. Outcomes were compared between frail and non-frail patients using univariate analyses and multivariable logistic regression adjusted for relevant covariates. Data analysis was performed between December 2025 and January 2026.
RESULTS: A total of 1,300 patients undergoing primary Shouldice inguinal hernia Repair were included (median age 64 years; 94.6% male). Overall, 29.7% of patients were classified as frail (mFI-5 ≥ 1). In univariate analyses, frail patients were older and had a higher body mass index and a greater comorbidity burden compared with non-frail patients. Frail patients also presented with larger hernia sizes for both first and second hernias. Postoperative complications were infrequent and did not differ significantly between frail and non-frail patients. In logistic regression analyses, frailty status was not independently associated with postoperative complications in either unadjusted or adjusted models.
CONCLUSION: Frailty was present in nearly one-third of patients undergoing Shouldice primary inguinal hernia Repair. Short-term postoperative complication rates were comparable between frail and non-frail patients, suggesting that primary Shouldice Repair is feasible in frail patients within a standardized elective setting.