ArticleHernia : the journal of hernias and abdominal wall surgery2026
Frailty in a low-risk elective setting: a quality improvement study at Shouldice Hospital.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aims to evaluate the impact of frailty on postoperative outcomes after Shouldice primary inguinal hernia Repair (SPIHR) as a quality control measure in a highly standardized elective setting.
methodsThis quality improvement study analyzed data from an ongoing prospective PROM program including patients undergoing primary unilateral or bilateral Shouldice inguinal hernia Repair. Frailty was assessed using the 5-item modified Frailty Index (mFI-5). Postoperative complications were identified via 30-40-day questionnaires and clinically verified when reported. Outcomes were compared between frail and non-frail patients using univariate analyses and multivariable logistic regression adjusted for relevant covariates. Data analysis was performed between December 2025 and January 2026.
resultsA total of 1,300 patients undergoing primary Shouldice inguinal hernia Repair were included (median age 64 years; 94.6% male). Overall, 29.7% of patients were classified as frail (mFI-5 ≥ 1). In univariate analyses, frail patients were older and had a higher body mass index and a greater comorbidity burden compared with non-frail patients. Frail patients also presented with larger hernia sizes for both first and second hernias. Postoperative complications were infrequent and did not differ significantly between frail and non-frail patients. In logistic regression analyses, frailty status was not independently associated with postoperative complications in either unadjusted or adjusted models.
conclusionFrailty was present in nearly one-third of patients undergoing Shouldice primary inguinal hernia Repair. Short-term postoperative complication rates were comparable between frail and non-frail patients, suggesting that primary Shouldice Repair is feasible in frail patients within a standardized elective setting.
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