Outcomes of Emergent Inguinal Hernia Repair in Veteran Octogenarians SERGIO HUERTA, M.D., THAI PHAM, M.D., SCOTT FOSTER, F.A.C.H.E., EDWARD H. LIVINGSTON, M.D., SEAN DINEEN, M.D. From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas Outcomes from emergent inguinal hernia (IH) repair in veteran octogenarians are not well de- scribed. We reviewed outcomes for this cohort from 2005 to 2012 at the VA North Texas Health Care System. There were 15 emergent (Group I) and 86 elective (Group II) operations performed in octogenarians. Age and American Society of Anesthesiologists status were similar in both groups. The rate of minor and major complications was higher in Group I compared with Group II (33 and 19% vs 22 and 2%, respectively; both Ps \ 0.001). Hospital length of stay (LOS) and intensive care unit LOS were also longer in Group I compared with Group II (6.7 6 7.0 and 2.5 6 4.4 vs 0.8 6 1.9 and 0.12 6 0.6 days, respectively; both Ps \ 0.001). Thirty-day mortality was 13 per cent for Group I and 0 per cent for Group II. Despite the high rate of comorbid conditions in our group, the risk associated with elective repair of IH was not prohibitive. In contrast, we observed that 15 per cent of patients presented with an incarcerated hernia during the study period and the mortality rate was 13 per cent in this cohort. Factors that might predict incarceration in veteran octogenarians need to be further investigated. A CCORDING TO DATA from the Veteran Health Ad- ministration Support Service Center (VSSC), the number of veteran patients 85 years old and older in- creased from 156,518 in 2002 to 511,070 in 2012. Projecting a similar fold increase for the next 10 years, the population of octogenarian veteran patients might be over 1.5 million in the next decade. Older veterans frequently present with a number of substantial comor- bid conditions compared with the private sector when they are evaluated for elective operations. 1 A study that collected data from the Veterans Affairs National Surgical Quality Improvement Project (VA-NSQIP) showed that octogenarian compared with younger vet- erans presenting for major noncardiac operations had a higher American Society of Anesthesiologists (ASA) Class III/IV (80 vs 60%), higher rate of congestive heart failure (6.4 vs 2.8%) as well as chronic obstructive pulmonary disease (13.8 vs 5.3%), and more often present with a do-not-resuscitate order (5.3 vs 1.3%). 2 In the same study, the 30-day overall operative mortality rate for major noncardiac operations was eight per cent in patients older than 80 years of age, but minor com- monly performed operations such as hernia repair, ca- rotid endarterectomy, and knee replacement carried a mortality rate of only two per cent in the same cohort of patients. 2 Inguinal herniorrhaphy is one of the most common elective operation in the United States 3 as well as a common elective general surgery operation performed at Veterans Affairs hospitals. Thus, the number of oc- togenarian veteran patients presenting for an elective repair of an inguinal hernia is likely to sharply increase over the next decade. The VA-NSQIP study showed that octogenarian veterans had fivefold increase risk of mortality compared with younger patients presenting for an inguinal herniorrhaphy (1.0 vs 0.2%). 2 A different study from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2008 demonstrated a mortality rate of 0.3 per cent in octogenarians undergoing an elective inguinal hernia repair. 4 The same study found a 10-fold increased mortality rate in nonagenarians compared with octogenarians and that the emergent repair of an inguinal hernia (IH) was an independent predictor of mortality in this cohort of patients. 4 Whereas morbidity and mortality associated with an elective repair of IHs in veteran octogenarians has been examined, the risk–benefit ratio of operating on such Presented at the Academic Surgical Congress, New Orleans, LA, February 5–7, 2013. Address correspondence and reprint requests to Sergio Huerta, M.D., Associate Professor, University of Texas Southwestern, VA North Texas Health Care System, 4500 S. Lancaster Road, Sur- gical Service (112), Dallas, TX 75126. E-mail: Sergio.Huerta@ UTSouthwestern.edu. 479