背景:对老年人偏好敏感手术的手术决策研究不足。腹壁疝修补术(VHR)是一种有限的数据来指导术前决策的手术。我们旨在根据包括手术和疝气特征在内的临床细微差别数据确定老年人VHR的风险。
方法:我们对2020年1月至2023年3月的密歇根手术质量协同核心优化疝注册进行了回顾性分析。主要结果是不同年龄组的术后并发症:18-64岁、65-74岁和≥75岁,手术方法的次要结果。混合效应logistic回归评估了微创手术(MIS)与30天并发症之间的关联,控制患者和疝气特征。
结果:在8,659名患者中,只有7%是75岁或以上。不同医院的MIS率各不相同[中位数=31.4%,IQR:(14.8-51.6%)]。总并发症发生率为2.2%。接受开放式与MIS方法的并发症风险在年龄组之间没有差异;然而,75岁以上接受腹腔镜修补术的患者风险增加(aOR=4.58,95%CI1.13~18.67).与风险相关的其他因素包括女性(aOR=2.10,95%CI1.51-2.93),BMI较高(AOR=1.18,95%CI1.03-1.34),疝宽度≥6cm(aOR=3.15,95%CI1.96-5.04),先前的修复(AOR=1.44,95%CI1.02-2.05),和组分分离(aOR=1.98,95%CI1.28-3.05)。最有可能发生MIS的患者为女性(aOR=1.21,95%CI1.09-1.34),黑色(aOR=1.30,95%CI1.12-1.52),较大的疝:2-5.9cm(aOR=1.76,95%CI1.57-1.97),或术中网状物放置(aOR=14.4,95%CI11.68-17.79)。考虑到医院(基线可能性SD=1.53,95%CI1.14-2.05)和外科医生(基线可能性SD=2.77,95%CI2.46-3.11)变异时,不同年龄段接受MIS的可能性没有差异。
结论:我们的研究结果表明疝气,术中,除年龄以外的患者特征增加VHR后并发症的可能性。这些发现可以使外科医生和老年患者考虑VHR的术前风险。
BACKGROUND: Surgical decision-making for preference-sensitive operations among older adults is understudied. Ventral hernia repair (VHR) is one operation where granular data are limited to guide preoperative decision-making. We aimed to determine risk for VHR in older adults given clinically nuanced data including surgical and hernia characteristics.
METHODS: We performed a retrospective analysis of the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry from January 2020 to March 2023. The primary outcome was postoperative complication across age groups: 18-64, 65-74, and ≥ 75 years, with secondary outcome of surgical approach. Mixed-effects logistic regression evaluated association between minimally invasive surgery (MIS) and 30-day complications, controlling for patient and hernia characteristics.
RESULTS: Among 8,659 patients, only 7% were 75 or older. MIS rates varied across hospitals [Median = 31.4%, IQR: (14.8-51.6%)]. The overall complication rate was 2.2%. Complication risk for undergoing open versus MIS approach did not vary between age groups; however, patients over age 75 undergoing laparoscopic repair had increased risk (aOR = 4.58, 95% CI 1.13-18.67). Other factors associated with risk included female sex (aOR = 2.10, 95% CI 1.51-2.93), higher BMI (aOR = 1.18, 95% CI 1.03-1.34), hernia width ≥ 6 cm (aOR = 3.15, 95% CI 1.96-5.04), previous repair (aOR = 1.44, 95% CI 1.02-2.05), and component separation (aOR = 1.98, 95% CI 1.28-3.05). Patients most likely to undergo MIS were female (aOR = 1.21, 95% CI 1.09-1.34), black (aOR = 1.30, 95% CI 1.12-1.52), with larger hernias: 2-5.9 cm (aOR = 1.76, 95% CI 1.57-1.97), or intraoperative mesh placement (aOR = 14.4, 95% CI 11.68-17.79). There was no difference in likelihood to receive MIS across ages when accounting for hospital (SD of baseline likelihood = 1.53, 95% CI 1.14-2.05) and surgeon (SD of baseline likelihood = 2.77, 95% CI 2.46-3.11) variation.
CONCLUSIONS: Our findings demonstrate that hernia, intraoperative, and patient characteristics other than age increase probability for complication following VHR. These findings can empower surgeons and older patients considering preoperative risk for VHR.