Emergency repair of incarcerated groin hernias in older adults: a retrospective cohort study of outcomes.

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.