CSA Home
Central Surgical Association

Back to 2022 Abstracts


Are Goal-Directed Recommendations Addressing The Barriers To Ventral Hernia Repair In Older Adults?
*Cameron Casson, *Julie Clanahan, *Britta Han, *Chloe Ferris, *Bradley Kushner, *Timothy Holden, Sara Holden
Washington University in St. Louis, St. Louis, MO

OBJECTIVE: Ventral hernias are increasingly common in older adults. However, multiple barriers exist that preclude ventral hernia repair (VHR), many of which are modifiable. Surgeons make goal-directed recommendations targeting these barriers. The goal of this study is to describe older adults with ventral hernias who are initially deemed non-operative candidates and determine if they ultimately progress to elective VHR.
METHODS: Patients ≥60 years with a ventral hernia who were evaluated in a specialty hernia clinic from January 2018 to August 2021 were retrospectively reviewed. Only patients deemed non-operative candidates with modifiable risk factors were included for analysis. Data collected included the specific barriers to being offered VHR and surgeon recommendations to address these barriers for future VHR eligibility. Patients lost to follow-up were contacted by phone.
RESULTS: A total of 559 patients ≥60 years were evaluated during the study period. Of these, 182 (32.6%) were non-operative candidates with modifiable risk factors (mean age 68 years [range 60-93], mean BMI 37.1[22.0-71.0]). Surgeon recommendations included weight loss (53.8%, mean BMI 43.4), comorbidity management by a medical specialist (44.0%), and smoking cessation (19.2%). Ultimately, 44 of the 182 patients (24.2%) met preoperative goals and progressed to elective VHR. Alternatively, 5 patients (2.7%) required urgent/emergent surgical intervention. In total, 16.3% of patients successfully lost weight, 25.7% quit smoking, and 27.1% had improvement in medical comorbidities and were able to progress to VHR. Importantly, 106 of 182 patients (58.2%) did not return to clinic after initial consultation. Of those contacted by phone (n=62), 35.5% had failed to achieve optimization goals. Initial BMI≥40 and surgeon-recommended preoperative weight loss were significantly associated with lack of patient follow-up (p=0.01, p=0.02) and progression to VHR (p=0.049, p=0.046).
CONCLUSIONS: Nearly one third of older adults evaluated in our clinic for ventral hernias were non-operative candidates, most often due to obesity, and over half of these patients were lost to follow-up. An increase in structured support is necessary for patients to achieve surgeon-specified preoperative goals. Further work to incorporate formal weight loss programs and collaborative comorbidity management may improve patient progression towards elective VHR, surgical outcomes, and ultimately quality of life.


Back to 2022 Abstracts