Background

Transversus abdominis release (TAR) is an effective procedure for the repair of complex ventral hernias. However, TAR is not a low risk operation, particularly in older adults who are disproportionately affected by multiple age-related risk factors. While past studies have suggested that age alone inconsistently predicts patient outcomes, data regarding age’s effect on postoperative outcomes and wound complications following a TAR are lacking.

Methods

Patients who underwent either an open or robotic bilateral TAR from 1/2018 to 9/2020 were eligible for the study. Patients were stratified by age groups (≥ 60 years vs. < 60 years and < 60, 60–70, and ≥ 70) and by both age and operative approach. The rates of key postoperative outcomes and wound morbidity were compared between the various cohorts.

Results

A total of 300 patients were included: 165 patients were ≥ 60 and 135 patients were < 60. Cohorts stratified by age were well-matched for important hernia factors: defect size (p = 0.31), BMI ≥ 30 (p = 0.46), OR time (p = 0.25), percent open TAR (p = 0.42), diabetes (p = 0.45) and history of prior surgical site infection (p = 0.40). The older cohort had significantly higher rates of coronary artery disease, hypertension, and COPD. On univariate analysis, cohorts stratified by age had similar rates of key postoperative and wound complications including in-hospital complications (p = 0.62), length of stay (p = 0.47), readmissions (p = 0.66), and surgical site occurrences (p = 0.68). Additionally, cohorts stratified by both age and operative approach also had similar outcomes. Multivariate analysis showed that chronological age was not independently associated with surgical site occurrences (p = 0.22), readmissions (p = 0.99), in-hospital complications (p = 0.15), or severe complications (p = 0.79).

Conclusion

Open and robotic TARs can be safely performed in older adults and chronological age alone is a poor predictor of patient morbidity following TAR. Further investigation of alternative preoperative screening tools that do not rely solely on age are needed to better optimize surgical outcomes in older adults following TAR.

中文翻译：

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实际年龄并不能预测腹横肌松解 (TAR) 术后的结果

 背景

腹横肌松解术（TAR）是修复复杂腹疝的有效手术。然而，TAR 并不是一种低风险手术，特别是对于受多种年龄相关风险因素影响尤为严重的老年人。虽然过去的研究表明，仅凭年龄并不能准确预测患者的治疗结果，但目前仍缺乏关于年龄对术后结果和 TAR 后伤口并发症的影响的数据。

 方法

2018 年 1 月至 2020 年 9 月期间接受开放式或机器人双侧 TAR 的患者有资格参加该研究。患者按年龄组（≥ 60 岁 vs. < 60 岁和 < 60、60-70 和 ≥ 70）以及年龄和手术方法进行分层。比较不同队列之间的关键术后结果和伤口发病率。

 结果

总共纳入 300 名患者：165 名患者≥ 60，135 名患者 < 60。按年龄分层的队列与重要的疝气因素匹配良好：缺损大小 ( p = 0.31)、BMI ≥ 30 ( p = 0.46) 、OR 时间 ( p = 0.25)、开放 TAR 百分比 ( p = 0.42)、糖尿病 ( p = 0.45) 和既往手术部位感染史 ( p = 0.40)。年龄较大的人群患冠心病、高血压和慢性阻塞性肺病的比例明显更高。在单变量分析中，按年龄分层的队列具有相似的术后和伤口并发症发生率，包括院内并发症 ( p = 0.62)、住院时间 ( p = 0.47)、再入院 ( p = 0.66) 和手术部位发生率 ( p = 0.66) = 0.68）。此外，按年龄和手术方法分层的队列也有类似的结果。多变量分析显示，实际年龄与手术部位发生率 ( p = 0.22)、再入院率 ( p = 0.99)、院内并发症 ( p = 0.15) 或严重并发症 ( p = 0.79) 并不独立相关。

 结论

开放式和机器人 TAR 可以在老年人中安全地进行，并且单独的实际年龄并不能很好地预测 TAR 后患者的发病率。需要进一步研究不仅仅依赖于年龄的替代术前筛查工具，以更好地优化 TAR 后老年人的手术结果。