Perioperative safety and long-term outcomes of mesh repair in nonagenarians undergoing elective inguinal hernia repair: a single-center retrospective study.

OBJECTIVE: To evaluate perioperative safety, long-term outcomes, and factors associated with Clavien-Dindo grade ≥ II complications in nonagenarians undergoing elective inguinal hernia repair. METHODS: The main cohort of this retrospective study included nonagenarians who underwent elective inguinal hernia repair between 2013 and2025. Preoperative, intraoperative, and postoperative data were collected. The primary outcome was Clavien-Dindo grade ≥ II complications. Univariable logistic regression was used to identify associated factors. Nonagenarians who underwent emergency groin hernia repair during the same period were analyzed separately as a supplementary descriptive cohort. RESULTS: The elective cohort comprised 152 patients (median age 91.0 years), all of whom underwent mesh repair (Lichtenstein in 129, 84.9%). Median hospital stay was 7.0 days, and median follow‑up was 30.0 months. Postoperative complications occurred in 22 patients (14.5%), including 12 (7.9%) with Clavien‑Dindo grade ≥ II. The 30‑day mortality was 1.3%. During the follow‑up, recurrence was detected in 2 patients (1.3%) and chronic pain in 6 (3.9%). In univariate logistic regression, preoperative functional dependence was significantly associated with grade ≥ II complications (odds ratio 16.27, 95% CI 2.82 to 93.86, P = 0.002). In the emergency repair cohort (n = 29), 10 patients (34.5%) developed grade ≥ II complications, all of which were surgery‑related deaths. CONCLUSIONS: In clinically selected nonagenarians undergoing elective inguinal hernia repair, mesh repair showed acceptable perioperative safety and favorable long-term local outcomes. Preoperative functional status, rather than chronological age alone, should be emphasized in surgical decision-making.