Abstract: Objective:To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.
Methods:The retrospective cohort study was adopted. The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age≥70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected. Of 675 patients undergoing ambulatory surgery, 594 patients with age<70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group. Four hundred sixtyfour patients undergoing inpatient surgery with age≥70 years were allocated into the inpatient surgery group. Observation indicators included: (1) efficacies of patients undergoing ambulatory surgery: ① type of anesthesia, surgical procedures and operation time, ② cases with delayed discharge and cases with unplanned readmission, ③postoperative complications, including wound infection and dehiscence, edema of scrotum, urinary retention, chronic pain and patch infection. (2) Efficacies of patients with inpatient surgery: ① type of anesthesia, surgical procedures and operation time, ② postoperative complications, including wound infection and dehiscence, edema of scrotum, urinary retention, chronic pain and patch infection, ③ duration of postoperative hospital stay. (3) Followup. Patients were regularly followed up using telephone interview at postoperative day 1, 2, 3, and using outpatient examination and telephone interview at postoperative week 2 and month 3, 6, 12 up to July 2016. Followup included the survival of patients, recurrence of hernia and number of readmission. Measurement data with normal distribution were represented as ±s and comparison between groups was evaluated with the t test. Comparison of count data were analyzed using the chisquare or Fisher exact probability.
Results:(1)Efficacies of patients undergoing ambulatory surgery: ① type of anesthesia, surgical procedures and operation time: patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia. The operation time in the under 70 years group and 70 years or older group was respectively (29±11)minutes and (28±10)minutes, with no statistically significant difference between 2 groups (t=0.378, P>0.05). ② The cases with delayed discharge and with unplanned readmission: there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group, with no statistically significant difference between the 2 groups (χ²=0.601, 0.137, P> 0.05). ③ The postoperative complications: wound infection and dehiscence, edema of scrotum, urinary retention and chronic pain were detected in 4, 2, 1, 3 patients in the under 70 years group and 1, 0, 0, 1 patients in the 70 years or older group, respectively, showing no statistically significant difference between the 2 groups (P> 0.05). No patch infection occured. (2) Efficacies of patients undergoing inpatient surgery: ① type of anesthesia, surgical procedures and operation time: patients in the inpatient surgery group underwent tensionfree repair under local anesthesia and operation time was (29±10)minutes. There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t=0.806, P> 0.05). ② The wound infection and dehiscence, edema of scrotum, urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3, 1, 1, 2 patients, showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P>0.05 ). No patch infection occured. ③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group, respectively. (3) Followup: 625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range, 2-18 months). One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation. There was no recurrence of hernia in the 70 years or older group. Of 464 patients in the inpatient surgery group, 432 were followed up for a median time of 9 months (range, 2-18 months), and 1 patient with recurrence of hernia was cured by reoperation.
Conclusion:Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.