Clinical scienceRandomized clinical trial comparing ambulatory and inpatient care after inguinal hernia repair in patients aged 65 years or older
Section snippets
Methods
The study was performed at the Helsinki University Jorvi Hospital Ambulatory Surgery Unit, which provides care for a population of about 270,000 inhabitants. Patients aged 65 years and older who were referred to the hospital for elective open repair of symptomatic unilateral or bilateral, primary or recurrent inguinal hernia were considered for participation in the study. Preoperative evaluation was performed at the study unit according to standard practice and patients were not invited to
Results
During a 2-year period from February 2006 to February 2008, 151 patients aged 65 to 90 years were assessed preoperatively at the ambulatory surgery unit. Of these, 89 were recruited, and 45 were randomized to receive care as outpatients and 44 as inpatients. One patient randomized to the inpatient group was unintentionally discharged home from the ambulatory surgery unit and therefore was analyzed as belonging to the ambulatory surgery group. Details of the inclusion and exclusion process are
Comments
There has been a significant shift toward ambulatory surgery during recent years. As the expanding elderly population requires more surgical services, the number of older patients presenting for ambulatory surgery will increase.1 There is, however, a lack of evidence from randomized trials on the feasibility of ambulatory surgery in the older population. We evaluated prospectively the suitability of ambulatory surgery to patients aged 65 years and older, referred to the same hospital for a
Conclusions
In medically stable patients aged 65 years and older, ambulatory surgery can be recommended as the primary choice of surgical care for open inguinal hernia repair. Ambulatory surgery was safe and most patients preferred it to inpatient care. The increasing number of patients without company available at home postoperatively necessitates arrangements for overnight stay facilities outside hospital inpatient wards.
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