Association of dementia with adverse outcomes after emergent hernia repair.

Abstract

As the prevalence of dementia within an aging population increases, its impact on surgical outcomes, particularly in emergent settings, is a growing concern. We aimed to evaluate the association between dementia and outcomes after emergent hernia repair. A retrospective analysis was performed of patients (≥65 years) undergoing nonelective hernia repair using the Nationwide Readmissions Database from 2016 to 2021. Patients were stratified on the basis of pre-existing dementia. Entropy balancing and multivariable regressions were used to assess the risk-adjusted association between dementia and in-hospital mortality, perioperative complications, nonhome discharge, and nonelective 30-day readmission. Of an estimated 137,755 patients undergoing emergent hernia repair, 8.2% had dementia. When compared with others, patients with dementia were generally older (82.7 vs 76.1 years), less commonly female (50.1 vs 53.0%) and more frequently insured by Medicare (94.0 vs 89.6%) (all P < .05). In addition, they had a greater burden of comorbidities (Elixhauser index: 3 [2-5] vs 3 [2-4]), including psychiatric disorders (17.8 vs 10.0%) (both P < .05). After entropy balancing and multivariable adjustment, dementia was associated with an increased risk of in-hospital mortality (adjusted odds ratio, 1.29; 95% confidence interval, 1.12-1.49). Additionally, dementia was independently associated with a greater likelihood of overall perioperative complications (adjusted odds ratio, 1.41; 95% confidence interval, 1.32-1.50), non-home discharge (adjusted odds ratio, 2.98; 95% confidence interval, 2.80-3.18), and readmission (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22). Dementia appears to be associated with inferior outcomes after emergent hernia repair, especially among elderly patients. Our findings highlight the need for heightened perioperative management and targeted strategies to optimize care in this population.