Clinical science
Randomized clinical trial comparing ambulatory and inpatient care after inguinal hernia repair in patients aged 65 years or older

https://doi.org/10.1016/j.amjsurg.2010.04.024Get rights and content

Abstract

Background

There is a lack of evidence from randomized studies of the feasibility of ambulatory surgery in patients aged 65 years and older.

Methods

Medically stable patients scheduled for open inguinal hernia repair, with postoperative care available at home, were randomized to receive treatment either as outpatients or inpatients. Younger patients undergoing the same procedure served as a reference group. Outcome measures during the 2 weeks after surgery were complications, unplanned admissions, visits to the hospital, unplanned visits to primary health care, and patients' acceptance of the type of provided care.

Results

Of 151 patients, 89 were included. Main reasons for exclusion were lack of postoperative company (16%), unwillingness to participate (13%), and medical conditions (10%). All outpatients were discharged home as planned, and none of the study patients were readmitted to the hospital. Patient satisfaction was high with no differences between the groups.

Conclusions

Ambulatory surgery was safe and well accepted by older, medically stable patients.

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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