title: Is the age of >65 years a risk factor for endoscopic treatment of primary inguinal hernia? Analysis of 24,571 patients from the Herniamed Registry.
abstract: BACKGROUND
  Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carried out. Besides, there is no definition to determine whether 65 years should really be considered to be the age limit.
  
  
  METHODS
  In the Herniamed Hernia Registry, it was possible to identify 24,571 patients with a primary inguinal hernia and aged at least 16 years who had been operated on between September 1, 2009, and April 15, 2013, using either the TAPP technique (n = 17,214) or TEP technique (n = 7,357). Patients in the age group up to and including 65 years (≤65 years) were compared with those older than 65 years (>65 years) in terms of their perioperative outcome. That was done first using unadjusted analysis and then multivariable analysis.
  
  
  RESULTS
  Unadjusted analysis revealed significantly different results for the intraoperative (1.19 vs 1.60%; p = 0,010), postoperative surgical (2.72 vs 4.59%; p < 0.001) and postoperative general complications (0.85 vs 1.98%; p < 0.001) as well as for complication-related reoperations (1.07 vs 1.37%; p = 0,044), which were more favorable in the ≤65 years age group. However, in multivariable analysis, it was not possible to confirm that for the intraoperative complications or the reoperations. Reoperations were needed more often for bilateral procedures (p < 0.001; OR 2.154 [1.699; 2.730]), higher ASA classification (IV vs I: p = 0.004; OR 6.001 [1.786; 20.167]), larger hernia defect and scrotal hernias. The impact of these factors, in addition to that of age >65 years, was also reflected in the postoperative complication rates. The age limit for increased onset of perioperative complication rates tends to be more than 80 rather than 65 years.
  
  
  CONCLUSIONS
  The higher perioperative complication rate associated with endoscopic/laparoscopic inguinal hernia surgery in patients older than 65 years is of multifactorial genesis and is observed in particular as from the age of 80 years.
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Mayer
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Lechner
authors.affiliation: StatConsult GmbH, Magdeburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Adolf
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Öfner
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Köhler
authors.affiliation: Department of General Surgery, Wilhelminenspital, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Fortelny
authors.affiliation: Hernia Center, Winghofer Medicum, Rottenburg am Neckar, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bittner
authors.affiliation: Department of Surgery and Center of Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
authors.forename: F
authors.initials: F
authors.lastname: Köckerling
mesh_terms: D000367:Age Factors; D000368:Aged; D001317:Austria / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology
keywords: Age; Complications; Inguinal hernia; Reoperation; TAPP; TEP