Outcomes and quality of life of frail patients following elective ventral hernia repair: Retrospective review of a national hernia collaborative

• Published in: The American journal of surgery 2024-07, Vol.233, p.65-71
• Main Authors: Whalen, Alison, Holla, Sahana, Renshaw, Savannah, Olson, Molly, Sreevalsan, Kavya, Poulose, Benjamin K., Collins, Courtney E.
• Format: Article
• Language: English
• Subjects: Abdomen; Chronic obstructive pulmonary disease; Collaboration; Frailty; Hernia; Hernias; Infectious diseases; Intestinal obstruction; Missing data; Mortality; Multivariable control; Older people; Outcomes; Patients; Population; Quality of life; Surgeons; Surgery; Surgical outcomes; Surgical site infections; Variance analysis; Ventral hernia repair
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.02.011

Ventral hernia repair (VHR) is one of the most common general surgery procedures among older adults but is often deferred due to a higher risk of complications. This study compares postoperative quality of life (QOL) and complications between frail and non-frail patients undergoing elective VHR. We hypothesized that frail patients would have higher complication rates and smaller gains in quality of life compared to non-frail patients. Patients 65 years of age and older, undergoing elective VHR between 2018 and 2022 were selected from the ACHQC (Abdominal Core Health Quality Collaborative) and grouped based on frailty scores obtained using the Modified Frailty Index (mFI-5). Logistic regression adjusting for hernia characteristics (size, recurrent, parastomal, incisional) were performed for 30-day outcomes including surgical site infections (SSI), surgical site occurrences (SSO), surgical site infections/occurrences requiring procedural intervention (SSOPI), and readmission. Multivariable analyses controlling for patient and procedure characteristics were performed comparing QOL scores (HerQLes scale, 0–100) at baseline, 30 days, 6 months and 1 year postoperatively. A total of 4888 patients were included, 29.17% non-frail, 47.87% frail, and 22.95% severely frail. On adjusted analysis, severely frail patients had higher odds of SSO (most commonly seroma formation) but no evidence of a difference in SSI, SSOPI, readmission or mortality. Severely frail patients had lower median QOL scores at baseline (48.3/100, IQR 26.1–71.7, p ​= ​0.001) but reported higher QOL scores at both 30-days (68.3/100, IQR 41.7–88.3, p ​= ​0.01) and 6-months (86.7/100, IQR 65.0–93.3, p ​= ​0.005). Severely frail patients reported similar increases in QOL and similar complications to their not frail counterparts. Our results demonstrate that appropriately selected older patients, even those who are severely frail, may benefit from elective VHR in the appropriate clinical circumstance. •Frail and not frail patients had similar complication rates after elective VHR.•No difference in readmission or mortality rates at 30-days.•Severely frail patients report similar increases in quality of life.