Outcomes of inguinal hernia repair in octogenarians: A propensity score–matched analysis of the Herniamed Registry

BACKGROUND: With increasing life expectancy, a growing proportion of inguinal hernia repairs is performed in elderly patients. Evidence regarding perioperative safety and long-term outcomes in octogenarians remains limited. This study compared perioperative outcomes and one-year follow-up between patients aged < 80 and ≥ 80 years using data from the Herniamed Registry. METHODS: A total of 394,309 fully documented unilateral primary inguinal hernia repairs with valid one-year follow-up were extracted from the Herniamed Registry (data export October 2025). After applying predefined inclusion and plausibility criteria, 45,576 patients aged ≥ 80 years and 348,733 patients aged < 80 years were eligible for analysis. A 1:1 propensity score-matched analysis was performed using demographic, hernia-related, surgical, and comorbidity variables, with exact matching for sex, surgical approach, and procedure type. Outcomes included intraoperative, general, and postoperative complications, complication-related reoperations, and one-year endpoints (pain at rest, pain on exertion, pain requiring treatment, recurrence, trocar hernia, secondary hemorrhage, seroma, and infection). McNemar's test and odds ratios were used for statistical comparison. RESULTS: Before matching, octogenarians more frequently underwent emergency surgery (6.8% vs. 2.1%), presented with scrotal or femoral hernias, and were more often treated under local or spinal anesthesia. Propensity score matching yielded 44,550 matched pairs. After matching, patients aged ≥ 80 years showed significantly higher rates of general and postoperative complications, reoperations, secondary hemorrhage, and infection. Conversely, one-year pain outcomes and recurrence rates were significantly lower in octogenarians. No significant differences were observed for intraoperative complications, trocar hernia, or seroma. CONCLUSIONS: Octogenarians undergoing inguinal hernia repair exhibit increased perioperative risk but favorable one-year outcomes regarding pain and recurrence. These findings support the overall safety and effectiveness of inguinal hernia repair in advanced age, provided that perioperative risk is carefully managed. Elective surgery should not be withheld solely due to age, and early intervention may reduce the risk of emergency presentations and improve postoperative outcomes.