评价70岁及以上老年患者在日间手术模式下行腹股沟疝修补术的安全性及可行性。

回顾性收集2021年1月至2023年12月于南充市中心医院胃肠疝外科行腹股沟疝修补术患者的临床资料。根据患者入院方式及年龄不同分为≥70岁日间组、≥70岁住院组和<70岁日间组3组，分别采用倾向评分匹配（PSM）方法将≥70岁日间组与≥70岁住院组、≥70岁日间组与<70岁日间组两两匹配研究。分别比较匹配后2组患者间术后恢复期的临床指标。

本研究纳入≥70岁行日间手术患者219例、≥70岁普通住院手术患者612例、<70岁行日间手术患者531例。经1∶1 PSM，≥70岁日间组与≥70岁住院组分别纳入208例患者进行对照研究，2组患者的出血、手术时间、术后发热、恶心、呕吐、尿潴留、静脉血栓栓塞（VTE）、血清肿、切口愈合情况、出院疼痛视觉模拟评分（VAS）、复发情况比较，差异均无统计学意义（P>0.05）；≥70岁住院组住院费用（15 070.09±3090.63）元高于≥70岁日间组（12 949.88±3439.28）元，差异有统计学意义（P<0.001）。经1∶1 PSM，≥70岁日间组与<70岁日间组分别纳入152例患者进行对比研究，2组患者的出血、手术时间、住院费用、术后发热、恶心、呕吐、尿潴留、VTE、血清肿、切口愈合情况、出院VAS评分、复发情况对比，差异均无统计学意义（P>0.05）。

基于PSM的回顾性研究显示，70岁及以上老年患者经麻醉风险评估（腹股沟疝日间手术指南要求）良好，虽有基础疾病，但并不需要复杂多学科合作诊疗者，开展日间疝手术是安全可行的。

To evaluate the safety and feasibility of inguinal hernia repair surgery in patients over 70 years old under day surgery mode.

Clinical data of patients who underwent inguinal hernia repair surgery in the Department of Gastrointestinal Hernia Surgery of Nanchong Central Hospital from January 2021 to December 2023 was retrospectively collected. According to the different admission methods and ages of patients, they were divided into three groups: ≥70 years old day surgery group, ≥70 years old hospitalization surgery group, and <70 years old day surgery group. Propensity score matching (PSM) method was used to match the ≥70 years old day surgery group with the ≥70 years old hospitalization surgery group, and the ≥70 years old day surgery group with the <70 year old day surgery group pairwise. The clinical indicators of postoperative recovery period between the two groups of patients after matching were compared respectively.

In this study, 219 patients ≥70 years old who underwent day surgery, 612 patients ≥70 years old who underwent ordinary in-patient surgery, and 531 patients <70 years old who underwent day surgery were included. Through a 1:1 PSM, 208 patients were included in the ≥70 years old day surgery group and the ≥70 years old hospitalization surgery group as a comparative study. There was no significant difference between the two groups in bleeding, operation time, postoperative fever, nausea, vomiting, urinary retention, venous thromboembolism (VTE), seroma, wound healing, discharge visual analogue scale (VAS) pain score, and recurrence (P>0.05). However, in the comparison of hospitalization costs between the two groups of patients[≥70 years old day surgery group (12 949.88±3439.28) yuan, ≥70 years old hospitalization surgery group (15 070.09±3090.63) yuan, P<0.001], the hospitalization surgery group had higher costs than the day surgery group, and the difference was statistically significant (P<0.05). Similarly, after a 1:1 PSM, 152 patients were included in the day surgery group ≥70 years old and the day surgery group <70 years old as a comparative study. There was no significant difference between the two groups in bleeding, operation time, hospital costs, postoperative fever, nausea, vomiting, urinary retention, VTE, seroma, incision healing, discharge VAS pain, and recurrence (P>0.05).

This retrospective study based on PSM showed that elderly patients over 70 years old who have good anesthesia risk assessment (as required by the guidelines for inguinal hernia day surgery), have underlying diseases, and do not require complex multidisciplinary cooperation for diagnosis and treatment, are safe and feasible to undergo hernia day surgery.