Hernia : the journal of hernias and abdominal wall surgery · 2026
Emergency repair of incarcerated groin hernias in older adults: a retrospective cohort study of outcomes.
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Güden İnan, Bozkurt Halil Alper, Kaya Melek Ezgi, Ercan Leman Damla, İlhan Mehmet, Gök Ali Fuat Kaan
Аннотация
BACKGROUND: Emergency surgery for incarcerated groin hernias (IGH) in older adults is associated with high morbidity. While age is a known factor, the impact of physiological reserve and functional frailty on outcomes remains poorly quantified.
OBJECTIVE: To evaluate the impact of comorbidity burden and frailty on postoperative outcomes in older adults (≥65 years) undergoing emergency IGH repair, compared to a younger cohort (<65 years).
METHODS: This retrospective cohort study included 135 consecutive patients (older adults, n=62; younger patients, n=73). Baseline risk was assessed using the Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS). Primary outcome was 30-day mortality; secondary outcomes included complications and ICU admission.
RESULTS: Older adults had significantly higher physiological and functional risk profiles compared to younger patients (Mean CCI: 4.6±1.3 vs. 1.7±1.1, p<0.001; Mean CFS:4.9±1.2 vs. 2.4±0.8, p<0.001). Intestinal obstruction was more prevalent in older adults(64.5% vs. 35.6%, p=0.001). While overall complication rates were similar (19.4% vs.16.4%, p=0.677), all 30-day mortalities (n=6, 4.4% total) occurred in the older adult group (9.7% vs. 0.0%, p=0.008). Mortality was primarily driven by cardiopulmonary failure, directly correlating with higher CCI and CFS scores.
CONCLUSIONS: In emergency IGH repair, 30-day mortality in older adults is driven by diminished physiological reserve and frailty rather than surgical technique. CCI and CFS are sensitive predictors of poor outcomes. High-risk patients (CFS ≥5 or CCI ≥4) require intensive perioperative optimization and closer postoperative monitoring.
OBJECTIVE: To evaluate the impact of comorbidity burden and frailty on postoperative outcomes in older adults (≥65 years) undergoing emergency IGH repair, compared to a younger cohort (<65 years).
METHODS: This retrospective cohort study included 135 consecutive patients (older adults, n=62; younger patients, n=73). Baseline risk was assessed using the Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS). Primary outcome was 30-day mortality; secondary outcomes included complications and ICU admission.
RESULTS: Older adults had significantly higher physiological and functional risk profiles compared to younger patients (Mean CCI: 4.6±1.3 vs. 1.7±1.1, p<0.001; Mean CFS:4.9±1.2 vs. 2.4±0.8, p<0.001). Intestinal obstruction was more prevalent in older adults(64.5% vs. 35.6%, p=0.001). While overall complication rates were similar (19.4% vs.16.4%, p=0.677), all 30-day mortalities (n=6, 4.4% total) occurred in the older adult group (9.7% vs. 0.0%, p=0.008). Mortality was primarily driven by cardiopulmonary failure, directly correlating with higher CCI and CFS scores.
CONCLUSIONS: In emergency IGH repair, 30-day mortality in older adults is driven by diminished physiological reserve and frailty rather than surgical technique. CCI and CFS are sensitive predictors of poor outcomes. High-risk patients (CFS ≥5 or CCI ≥4) require intensive perioperative optimization and closer postoperative monitoring.