Age alone is not a barrier: Outcomes of geriatric patients undergoing component separation during open abdominal wall reconstruction.

BACKGROUND: The component separation technique is used in complex, open abdominal wall reconstruction to facilitate fascial closure. This study compared outcomes between geriatric and nongeriatric patients undergoing open abdominal wall reconstruction with the component separation technique and evaluated outcomes before and after the implementation of a geriatric medicine program. METHODS: Patients undergoing open abdominal wall reconstruction + component separation technique at a single institution were stratified by age: <65 versus ≥65. A subgroup analysis compared outcomes before and after the implementation of a multidisciplinary, perioperative, optimization geriatric medicine program. Standard descriptive, comparative, and logistic regression analyses were performed. RESULTS: Among 748 patients (475 nongeriatric, 273 geriatric), nongeriatric patients had a higher body mass index (33.4 ± 6.7 vs 30.6 ± 5.8 kg/m2; P < .001) and fewer comorbidities (4.5 ± 2.5 vs 5.2 ± 2.3; P < .001). The mean age was 52.0 ± 9.1 vs 70.7 ± 4.4 years (P < .001). Most hernias were recurrent (67.8% vs 68.5%; P = .841) and giant (321.1 ± 243.3 vs 307.5 ± 182.3 cm2; P = .756). Length of stay (8.3 ± 18.3 vs 7.8 ± 6.0 days; P = .126) and wound complication rates (32.2% vs 29.7%; P = .471) were not different; age was not an independent predictor of wound morbidity. Geriatric patients had higher rates of postoperative pneumonia (1.3% vs 4.5%; P = .009) and intensive care unit transfer (8.9% vs 16.7%; P = .007). Subgroup analysis identified 94 pre-geriatric medicine program and 47 post-geriatric medicine program geriatric patients. Pre-geriatric medicine program patients had more comorbidities (5.4 ± 2.3 vs 4.4 ± 2.1; P = .015). Geriatric medicine program implementation was associated with reduced length of stay (6.5 ± 2.6 vs 5.6 ± 5.8; P < .001), with no postoperative pneumonias in the post-geriatric medicine program cohort. While intensive care unit transfers decreased (15.9% vs 7.3%; P = .245), this was not statistically significant. There was no difference in 30-day readmission (7.4% vs 6.4%; P > .05). CONCLUSION: Component separation technique demonstrates similar surgical outcomes in geriatric and nongeriatric patients, although rates of pneumonia and intensive care unit transfers were higher. Geriatric medicine program implementation was associated with fewer medical complications and shorter length of stay, with no increase in readmissions.