Outpatient repair for inguinal hernia in elderly patients: Still a challenge?

Palumbo, Piergaspare; Amatucci, Chiara; B, Perotti; Zullino, Antonio; Dezzi, Claudia; Vietri, F

doi:10.1016/j.ijsu.2014.08.393

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…The mortality rate was zero in all three intervention groups as no deaths were reported. Only one study had mortality as a primary outcome.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 46 studies reported mortality within 90 days. The studies covered 10 332 patients: 7976 had LA, 722 regional anaesthesia and 1634 GA. Methods of follow‐up included clinical examination, telephone call, questionnaire , contact with family doctor and electronic patient data management. Six studies did not report methods of follow‐up.…”

Section: Resultsmentioning

confidence: 99%

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Network meta-analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia

Olsen

Öberg

Andresen

et al. 2019

British Journal of Surgery

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Background Urinary retention and mortality after open repair of inguinal hernia may depend on the type of anaesthesia. The aim of this study was to investigate possible differences in urinary retention and mortality in adults after Lichtenstein repair under different types of anaesthesia. Methods Systematic searches were conducted in the Cochrane, PubMed and Embase databases, with the last search on 1 August 2018. Eligible studies included adult patients having elective unilateral inguinal hernia repair by the Lichtenstein technique under local, regional or general anaesthesia. Outcomes were urinary retention and mortality, which were compared between the three types of anaesthesia using meta‐analyses and a network meta‐analysis. Results In total, 53 studies covering 11 683 patients were included. Crude rates of urinary retention were 0·1 (95 per cent c.i. 0 to 0·2) per cent for local anaesthesia, 8·6 (6·6 to 10·5) per cent for regional anaesthesia and 1·4 (0·6 to 2·2) per cent for general anaesthesia. No death related to the type of anaesthesia was reported. The network meta‐analysis showed a higher risk of urinary retention after both regional (odds ratio (OR) 15·73, 95 per cent c.i. 5·85 to 42·32; P < 0·001) and general (OR 4·07, 1·07 to 15·48; P = 0·040) anaesthesia compared with local anaesthesia, and a higher risk after regional compared with general anaesthesia (OR 3·87, 1·10 to 13·60; P = 0·035). Meta‐analyses showed a higher risk of urinary retention after regional compared with local anaesthesia (P < 0·001), but no difference between general and local anaesthesia (P = 0·08). Conclusion Local or general anaesthesia had significantly lower risks of urinary retention than regional anaesthesia. Differences in mortality could not be assessed as there were no deaths after elective Lichtenstein repair. Registration number: CRD42018087115 ( https://www.crd.york.ac.uk/prospero).

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“…The mortality rate was zero in all three intervention groups as no deaths were reported. Only one study had mortality as a primary outcome.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Network meta-analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia

Olsen

Öberg

Andresen

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

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“…Patients with an age ≤18 years, ASA score III-IV, BMI ≤15 or >40, hepatic failure, acute kidney injury or chronic renal failure, heart failure, reported allergy to local anesthetics, congenital or acquired bleeding disorders were considered not eligible for the surgical and the anesthesiological procedure. Patients with an age ≥75 years were not excluded from the study, because, even if they could have worse general health status and higher ASA scores than the younger patients, the surgical morbidity results to be not significantly different [13].…”

Section: Methodsmentioning

confidence: 99%

Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study

et al. 2019

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AbstractSafety and effectiveness evaluation of subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose (30mg) in combination with Fentanyl (20mcg), for the purpose of ensuring an optimal analgesia in open inguinal hernia repair.Although the local anesthesia is the first line treatment for open inguinal hernia repair, a minority of patients is not eligible because of obesity or big groin hernia, requiring a high dose of local anesthetic. Subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose in combination with Fentanyl may be a good alternative.Thirty patients were treated with intrathecal association of Prilocaine 30 mg and Fentanyl 20 mcg (group PF); they were compared to a group of fifty three ones, previously treated with a classic procedure with intrathecal Prilocaine 60 mg (group P).The sensitive blockage remained within an higher limit at T12 level in the patients of PF group, and a lower limit at S1 level 50 minutes after the anesthesia, while in the P group the anesthetic tended to migrate (p<0.0001). In PF group 70 minutes after the anesthesia 21 patients had a Bromage score equal to 0 and 9 patients equal to 9 (in P group, 19 patients had a score equal to 3, 8 to 2 and 3 to 1, p<0.0001).Subarachnoid anesthesia using Prilocaine 30 mg + Fentanyl 20 mcg could be stated as a viable alternative to local anesthesia in selected patients.

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“…Today, for example, surgeons routinely perform elective laparoscopic cholecystectomy, inguinal hernia repair, and partial mastectomy in an outpatient setting. 1 – 3 At many institutions, surgeons commonly perform parathyroidectomy and thyroid lobectomy as day-surgery procedures requiring only a short period of observation in the recovery room, and some surgeons are even applying this management paradigm to total thyroidectomy. 4 Indeed, many high-volume surgeons are performing thyroidectomy in an outpatient setting (same-day surgery) as the rule rather than the exception.…”

Section: Introductionmentioning

confidence: 99%

Is Outpatient Thyroid Surgery for Everyone?

Butler

Oltmann

2017

Clin Med Insights Ear Nose Throat

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Thyroidectomy is a common surgical procedure. Traditionally, surgeons have performed thyroidectomy on an inpatient basis. However, consistent with current trends in surgery, some practices are transitioning thyroidectomy to an outpatient setting. Although concerns for hypocalcemia and postoperative bleeding exist regardless of surgeon experience, multiple studies demonstrate that outpatient thyroidectomy is safe in the hands of high-volume surgeons. Indeed, experienced thyroid surgeons who perform thyroidectomy in an outpatient setting experience excellent patient outcomes and reduced costs. However, outpatient thyroidectomy may not be suitable for all surgeons, hospitals, or patients. When evaluating whether to implement an outpatient thyroid program, a practice should consider a number of important factors including the team performing the procedure, the hospital, and the patient. With the appropriate staff education and experience, hospital setting, and patient selection, practices in a multitude of settings can successfully develop a safe, cost-effective outpatient thyroid program.

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Outpatient repair for inguinal hernia in elderly patients: Still a challenge?

Abstract: Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment.

Cited by 20 publications

References 18 publications

Network meta-analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia

Network meta-analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia

Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study

Is Outpatient Thyroid Surgery for Everyone?

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