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We performed a retrospective review of a national hernia database (The Abdominal Core Health Quality Collaborative) to compare rates of postoperative complications for propensity matched older adults undergoing robotic vs. open retromuscular ventral hernia repair. We found that despite longer OR times, the robotic approach resulted in much shorter lengths of stay with equivalent complication and readmission rates.To describe 30-day outcomes including post-operative complications, readmissions, and quality of life score changes for older adults undergoing elective ventral hernia repair with retromuscular mesh placement and to compare rates of these outcomes for individuals undergoing robotic versus open approaches.Over one third of patients presenting for elective ventral hernia repair are over the age of 65 and many have complex surgical histories that warrant intricate hernia repairs. Robotic ventral hernia repairs have gained increasing popularity in the US and in some studies have demonstrated decreased rates of postoperative complications, and less pain resulting in shorter hospital stays. However, the robotic approach has several downsides including prolonged operative times as well as the use of pneumoperitoneum which may be risky in older patients.We performed a retrospective review of prospectively collected data in a national hernia specific registry (the Abdominal Core Health Quality Collaborative) and identified patients over the age of 65 undergoing either an open or robotic retromuscular ventral hernia repair. After propensity score matching adjusting for demographic, clinical, and hernia related factors, logistic regression was used to compare 30-day complications, readmission, and quality of life (QoL) scores as captured by the HerQLes scale for patients undergoing each approach.Of 2128 patients who met inclusion criteria, 1695 (79.7%) underwent open ventral hernia repair while 433 (20.3%) underwent robotic repair. After propensity score matching, there were 350 robotic cases and 759 open cases for analysis. Patients undergoing robotic repairs demonstrated significantly shorter length of stays (1 vs 4 days, P0.01) and had equivalent odds of both 30-day post-operative complications (OR 1.15 95% confidence interval 0.92-1.44) and readmission (OR 1.09 95% confidence interval 0.74-1.6) compared to the open approach. QoL scores were similar between groups at 30 days but were slightly better for robotic patients at 1 year (92 vs 84 P0.01).Robotic ventral hernia repair is an option for appropriately selected older patients undergoing retromuscular ventral hernia repair, demonstrating shorter hospital stays and equivalent rates of complications and readmissions in the post-operative period. However, more data is needed regarding QoL outcomes and long-term function, especially as it relates to recurrence rates, between the two approaches.

BACKGROUND Emergency general surgery (EGS) presents a challenge for frail, geriatric individuals who often have extensive comorbidities affecting postoperative recovery. Previous studies have shown an association between increasing frailty and adverse outcomes following elective and EGS; no study has explored the same for the geriatric patient population using the modified 5-item frailty index (mFI-5) score. MATERIALS AND METHODS A retrospective cohort study was performed using the 2012-2017 American College of Surgeons - National Surgical Quality Improvement Program database to identify geriatric patients (≥65 years) undergoing EGS procedures within 48 h of admission. The previously validated mFI-5 score was used to assess preoperative frailty. The study cohort was divided into four groups: mFI-5 = 0, mFI-5 = 1, mFI-5 = 2, and mFI-5 ≥ 3; the impact of increasing mFI-5 score on failure-to-rescue (FTR), 30-day complications, readmissions, reoperations, and mortality was assessed. RESULTS A total of 47,216 patients were included: 27.4% with mFI-5 = 0, 45% with mFI-5 = 1, 22.1% with mFI-5 = 2, and 5.5% with mFI-5 ≥ 3. Following multivariate analyses, increasing mFI-5 score was associated with higher odds of FTR (mFI-5 = 1: odds ratio (OR) 1.48, p=0.003; mFI-5 = 2: OR 2.66, p

BACKGROUND Falls are the leading cause of fatal injury, and the most common cause of nonfatal trauma, among older adults. However, patient perspectives on preferences for obtaining fall education are not well reported. OBJECTIVE To identify components of successful fall prevention education. DESIGN Prospective qualitative study. SETTING Tertiary care center; institutional. PARTICIPANTS Adults aged 65 years or older with a history of falls who received services from inpatient trauma or outpatient geriatric services. INTERVENTIONS One-hour face-to-face semistructured interview. MAIN OUTCOME MEASURE Semistructured interviews sought to determine participants' history of fall education and perceived strengths and weaknesses of various formats of fall education. RESULTS Nearly all participants (9/10) indicated they had not received fall prevention education of any kind. Many participants (6/10) reported that, despite not receiving any formal education about falls, they had either given or received information about falls from other older adults in their communities. Participants indicated that framing fall education as a part of healthy aging would be more desirable and mentioned involving participants' families as part of the education. The majority of participants (7/10) suggested fall education be delivered through in-person discussion with providers, and most (9/10) indicated this would provide a personalized approach with opportunity for questions. Participants specified fall education should consist of both environmental modifications (5/10) and awareness of one's surroundings (4/10). CONCLUSIONS Despite histories of falls, nearly all participants reported they had not received formal fall education. However, many indicated they received fall information informally through their communities. Participants agreed successful fall prevention education would be delivered in an empowering way by a trusted member of the care team.

An increasing proportion of ventral hernia patients are over age 65. These patients are frequently offered watchful waiting rather than surgical intervention due to their frail state or perioperative risk. However, many in this age group suffer from significant quality of life impacts that are not well understood. We performed a retrospective cohort study using data from the Abdominal Core Health Quality Collaborative (ACHQC), including adults undergoing elective ventral hernia repair from 2013 to 2019. Median differences in Hernia-Related Quality of Life Survey (HerQLes) summary scores at baseline, 30-days, 6-months, and 1 year post operatively were compared in four age categories (18–40, 40–64, 65–75, 76 +) using multivariable regression. Secondary outcomes included major post-operative complications and mortality. Of 6681 patients meeting inclusion criteria, 13.5% were 18–40, 55.8% were 41–64, 25.2% were 65–75, and 5% were 76 + . Patients in the 65–75 age group and those over 76 had higher mean baseline HerQLes scores (51.7 and 60.8) compared to those in the 18–40 and 41–64 groups (45 and 43.3, p

Robotic–assisted retromuscular repairs reduce length of stay compared to open surgery. However, no study has evaluated the long-term impact on abdominal core quality of life. Retrospective cohort study performed using prospectively collected data from the Americas Hernia Society Quality Collaborative (AHSQC) including adults who underwent open or robotic-assisted retromuscular, incisional hernia repair between 2013 and 2019. Differences in Hernia-Related Quality of Life Survey (HerQLes) scores at baseline and 1 year postoperatively were compared using multivariable regression models. Secondary outcomes included perioperative complications, wound morbidity, and hernia recurrence. 236 patients underwent open (N = 194) and robotic (N = 42) repairs. Median age was 61 years. The open group had larger hernia widths (median [IQR], 13 [9–16] vs. 7 [5–9] cm) and longer LOS (5 [4–6] vs. 1.5 [1–3] days). Median HerQLes summary scores at 1 year were similar at 88 [67, 93] points for open vs 90 [58, 94] for robotic arm. Wound morbidity rates were similar. On multivariate analysis, there was no difference in HerQLes summary score improvement 1 year after repair between techniques (3.3, CI [− 7.7, 14.3]; p = 0.52), however, patients with a comparatively larger hernia width of 7 cm had a 5.9 (CI [1.1, 10.8], p = 0.02) increase in HerQLes scores, and patients with a higher ASA class (3–5) saw an 11-point score improvement (CI [2.2, 20.0], p = 0.02) regardless of approach. Smoking, BMI above 30, or hernia recurrence had no significant impact, while COPD hindered scores (− 17.0, CI [− 32.3, − 1.7], p = 0.03). Improvement in abdominal core quality of life after repair is comparable between open and robotic retromuscular techniques. Larger hernia defects and higher ASA class patients benefitted the greatest. Robotic approaches offer shorter LOS with comparable recurrence and wound morbidity rates 1 year after surgery. The surgical approach should be personalized and guided by the surgeon’s individual and institutional expertise.

Background An increasing body of information suggests that preoperative physical activity level can impact postoperative outcomes. We sought to investigate this relationship in patients undergoing ventral hernia repair (VHR). Methods The Abdominal Core Health Quality Collaborative registry was used to identify patients undergoing a VHR between 2013 and 2019. Patient-reported preoperative exercise level was used to stratify the study population into 4 groups: none (no reported exercise), sporadic (once a month), moderate (once per week), and intense (more than once per week). Multi-variate logistic regression analyses were used to assess the impact of preoperative exercise frequency on postoperative outcomes, including complications, hospital readmissions and length of stay. Changes in quality of life and pain from baseline to 30-days postoperatively were assessed using the Hernia-Related Quality of Life Survey and National Institutes of Health Patient-Reported Outcomes Measurement Information System 3A Pain Scale. Results A total of 2,994 patients were included in the study, out of which 1,519 (50.7%) patients reported no preoperative exercise, 662 (22.1%) sporadic exercise, 467 (15.6%) moderate exercise, and 346 (11.6%) intense exercise. A total of 1,253 patients (19.2%) experienced a postoperative complication, out of which 249 (3.8%) had a surgical site infection. After multi-variable analysis and adjusting for demographics, comorbidities, and hernia characteristics, increasing exercise frequency (versus no reported exercise) was associated with significantly lower odds of experiencing any postoperative complication (sporadic: odds ratio 0.70; P = .008; moderate: odds ratio 0.62, P = .006; intense: odds ratio 0.67, P = .04), as well as lower odds of readmission (sporadic: odds ratio 0.04; moderate: odds ratio 0.40; intense: odds ratio 0.03; P = .01). Exercise level was not associated with length of stay (sporadic: P = .36; moderate: P = .19; intense: P = .95). No significant differences were found in changes in quality of life or pain from baseline to 30-days after surgery (Hernia-Related Quality of Life Survey, P = .24; National Institutes of Health Patient-Reported Outcomes Measurement Information System 3A P = .14). Conclusion Patients reporting greater exercise frequency before surgery demonstrated decreased risk of complications and readmission after undergoing ventral hernia repair. Increasing preoperative exercise participation through targeted prehabilitation programs may be a viable way for patients to reduce complications associated with VHR and improve their postoperative recovery.

Background: Falls are the leading cause of fatal injury, and most common cause of non-fatal trauma, among older adults. We sought to elicit older patient’s perspectives on fall risks for the general population as well as contributions to any personal falls to identify opportunities to improve fall education. Methods: Ten patients with a history of falls from inpatient trauma and outpatient geriatric services were interviewed. Transcripts were analyzed independently by five individuals using triangulation and constant comparison (NVivo11, QSR International) to compare fall risks to fall causes. Results: All patients reported that either they (9/10 participants) or someone they knew (8/10) had fallen. Despite this, only two personally worried about falling. Patient perceptions of fall risks fell into seven major themes: physiologic decline (8/10); underestimating limitations (7/10); environmental hazards (7/10), lack of awareness/rushing (4/10), misuse/lack of walking aids (3/10); positional transitions (2/10), and improper footwear (1/10). In contrast, the most commonly reported causes of personal falls were lack of awareness/rushing (7/10), environmental hazards (3/10), misuse/lack of walking aids (2/10), improper footwear (2/10), physiologic decline (2/10), underestimating limitations (1/10) and positional transitions (1/10). In general tended to attribute their own falls to their surroundings and were less likely to attribute physical or psychological limitations. Conclusion: Despite participants identifying falls as a serious problem, they were unlikely to worry about falling themselves. Participants were able to identify common fall risks. However, when speaking about personal experience, they were more likely to blame environmental hazards or rushing, and minimized the role of physiologic decline and personal limitations.

Hernia-Related Quality of Life Survey (HerQLes) assesses quality of life (QoL) after hernia repair, but the minimal clinically important difference (MCID) is unknown.Using 2013-2019 data from the Abdominal Core Health Quality Collaborative, HerQLes summary scores were calculated for VHR patients at baseline and 1-year. MCID was calculated using distribution-based method. Multivariate regression identified factors associated with exceeding MCID at 1 year.1817 patients met criteria. MCID was identified as a change in HerQLes of at least 15.6 points. Mean 1-year post-op score was 74.9 (SD ± 26.2), which exceeded the MCID threshold (p 0.001). Patients with increasing hernia width had higher odds of exceeding MCID at 1 year post-op (OR 1.04, p 0.01), as did patients with greater ASA class (OR 8.9, p 0.01).Using MCID can help identify patients who may significantly improve QoL after VHR, as well as power clinical trials with QoL as primary outcome.