Turkish Journal of Geriatrics 2018 , Vol 21, Issue 2
Dilek ÜNAL1, İpek ÖZYAYLALI2, İsmail Hakan KULAÇOĞLU3
1Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
2Haymana State Hospital, General Surgery, Ankara, Turkey
3Ankara Hernia Center, General Surgery, Ankara, Turkey
DOI : 10.31086/tjgeri.2018240426 Materials and Method: A retrospective medical record review of geriatric patients aged ?65 years (Group G, n=185) who had undergone outpatient inguinal hernia repair under local infiltration anesthesia (LIA) and sedation was conducted. Their data were compared with those of a group of nongeriatric patients aged 18?64 years (Group C, n=185). Patient selection, anesthetic and surgical care, and discharge criteria were protocol-based. Safety was evaluated in terms of incidence of adverse events, discharge delay, unanticipated admission and readmission and time to discharge.

Results: Results for the Groups G and C were age 73.2±7.1 vs. 43.9±12.3 years, number of high-risk patients with American Society of Anesthesiologists classification (ASA) III (n=55 [30%] vs. 5 [3%]), ASA IV (n=4 [2%] vs. 1 [0.5%]), minimal sedation was used in 158 vs. 163 patients, midazolam dose 2.7±1.1 vs. 4.6±1.7 mg, fentanyl dose 63.4±28.6 vs. 88.1±32.4 ?g, lidocaine dose 246.6±59.9 vs. 198.6±69.8 mg, and bupivacaine dose 39±9.5 vs. 47.7±10.7 mg, respectively. Times to discharge were 102±19 min and 91.2±22.5 min in Groups G and C, respectively. Groups were similar regarding the rate of intraoperative and postoperative adverse events, except for ecchymosis (n=2 in Group G vs. n=10 in Group C) and the rates of discharge delay, unanticipated admission, and readmission.

Conclusion: Outpatient inguinal herniorrhaphy under LIA and sedation in geriatric patients is as safe as in the nongeriatric patients, provided that protocol-based preoperative evaluation and discharge criteria and appropriate anesthetic management and surgical techniques are followed. Keywords : Geriatrics; Outpatient; General Surgery; Herniorrhaphy