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Findings published in the Journal of the Society of Laparoscopic & Robotic Surgeons show that minimally invasive surgery is safe and effective and leads to shorter length of stay (LOS) in frail patients undergoing emergency hernia repair.

The results are based on a study by Vihas Mahendrakumar Patel, MD, and colleagues who assessed whether minimally invasive surgery vs open surgery led to improved outcomes for managing emergency hernia repair in frail patients.

Using the National Surgical Quality Improvement Program database, they selected files from 2018 to 2020 to identify patients who underwent emergency hernia repair (groin or ventral). A Modified 5-Item Frailty Index score was calculated for each patient; only frail patients with a score of 2 or greater were included. The primary outcome was 30-day mortality, and the secondary outcomes included discharge location and hospital LOS.

The study included 1,893 patients. The majority (56.5%) were women, White (76.7%), and aged 66 years and older (61.4%). Most patients (83.6%) underwent open hernia repair. Overall, 15.9% of patients experienced a postoperative complication. The most common complications were 30-day readmission (12.3%), return to the operating room and pneumonia (5.0% each), and being on a ventilator for more than 48 hours (4.7%).

Benefits of Minimally Invasive Surgery

Minimally invasive surgery did not significantly increase mortality rates or impact discharge location; however, this approach led to shorter LOS for this patient population. Overall, the 30-day mortality rate was 5.23%. Of 1,583 patients who underwent open surgery, 5.3% died before 30 days. Among the 310 patients who had minimally invasive surgery, 4.8% died. After adjusting for covariates, the surgical procedure was not associated with a difference in 30-day mortality (P=0.57) or discharge destination (P=0.98).

For the overall cohort, the median days from surgical procedure to discharge was 4 days. Open surgery was associated with longer LOS than minimally invasive surgery (4 days vs 3 days, respectively). This difference was statistically significant after adjusting for covariates for minimally invasive surgery compared with open surgery (HR, 1.24; 95% CI, 1.07-1.43; P=0.005).

“While frail patients comprise a vulnerable population, they should not be excluded from surgical interventions in emergent situations. Rather, their care should be optimized to improve their outcomes,” the researchers concluded.

They noted that prospective studies are warranted to validate best practices in treating this patient population and to implement frailty-measurement indexes in emergency perioperative settings.