Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry
Authors: Ceresoli M. , Carissimi F. , Nigro A. , Fransvea P. , Lepre L. , Braga M. , Costa G. ,   List of Elderly Risk Assessment and Surgical Outcome (ERASO) Collaborative Study Group endorsed by SICUT, ACOI, SICG, SICE, and Italian Chapter of WSES, Agresta F. , Alemanno G. , Anania G. , Antropoli M. , Argenio G. , Atzeni J. , Avenia N. , Azzinnaro A. , Baldazzi G. , Balducci G. , Barbera G. , Bellanova G. , Bergamini C. , Bersigotti L. , Bianchi P. P. , Bombardini C. , Borzellino G. , Bozzo S. , Brachini G. , Buonanno G. M. , Canini T. , Cardella S. , Carrara G. , Cassini D. , Castriconi M. , Ceccarelli G. , Celi D. , Ceresoli M. , Chiappetta M. , Chiarugi M. , Cillara N. , Cimino F. , Cobuccio L. , Cocorullo G. , Colangelo E. , Costa G. , Crucitti A. , DallaCaneva P. , Luca M. , de Manzoni Garberini A. , De Nisco C. , De Prizio M. , De Sol A. , Dibella A. , Falcioni T. , Falco N. , Farina C. , Finotti E. , Fontana T. , Francioni G. , Fransvea P. , Frezza B. , Garbarino G. , Garulli G. , Genna M. , Giannessi S. , Gioffrè A. , Giordano A. , Gozzo D. , Grimaldi S. , Gulotta G. , Iacopini V. , Iarussi T. , Laracca G. , Laterza E. , Leonardi A. , Lepre L. , Lorenzon L. , Luridiana G. , Malagnino A. , Mar G. , Marini P. , Marzaioli R. , Massa G. , Mecarelli V. , Mercantini P. , Mingoli A. , Nigri G. , Occhionorelli S. , Paderno N. , Palini G. M. , Paradies D. , Paroli M. , Perrone F. , Petrucciani N. , Petruzzelli L. , Pezzolla A. , Piazza D. , Piazza V. , Piccoli M. , Pisanu A. , Podda M. , Poillucci G. , Porfidia R. , Rossi G. , Ruscelli P. , Spagnoli A. , Sulis R. , Tartaglia D. , Tranà C. , Travaglino A. , Tomaiuolo P. , Valeri A. , Vasquez G. , Zago M. , Zanoni E. 
Published: July 2020

Abstract
Purpose
The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed.

Methods
This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed.

Results
259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality

Conclusion
Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation