Is elective hernia repair worthwhile in old patients?

Objective: To find out if elective herniorraphy in patients aged 75 and ove r is worthwhile. Design: Retrospective study. Setting: District hospital, Sweden. Subjects: 146 consecutive patients aged 75 years or more, who had their her nias repaired during the period 1992-95. Main outcome measures: Patient satisfaction measured by a five-point analog ue scale. Clinical and personal details, morbidity, mortality, and surgical variables were obtained from case records. Results: Community social service was not required by 114 (78%) of the pati ents and 15 (22%) had no preoperative complaints. Our patients rated their satisfaction with their choice to have an operation, as well as its effect on their preoperative symptoms as 4.9. Emergency operations (p = 0.02), fem oral hernias (p = 0.01) and direct inguinal hernias (direct:indirect ratio 0.81) were more common in this age group. Femoral and direct inguinal herni as tended to recur more often than usual. Emergency operation, dementia, an d diabetes were associated with a reduced short-term survival. Conclusion: Elective hernia repair in an elderly population is highly appre ciated by the patients, and worthwhile. If coexisting disease and domestic arrangements are controlled, the patients' need for hospital care can be mi nimised. Mesh is recommended in femoral and direct inguinal hernias, which were associated with an increased reoperation frequency. A more vigilant pr otocol of indications for hernia surgery in the aged may minimise the need for both emergency and unnecessary operations.