Preoperative Geriatric Medicine Evaluation in a Multidisciplinary Abdominal Wall Reconstruction Clinic and Outcomes in Geriatric Patients

Alexis M Holland; Mary C Devane; Gregory T Scarola; William R Lorenz; Hadley H Wilson; Sullivan A Ayuso; Kent W Kercher; Vedra A Augenstein; B Todd Heniford

doi:10.1097/XCS.0000000000001791

Preoperative Geriatric Medicine Evaluation in a Multidisciplinary Abdominal Wall Reconstruction Clinic and Outcomes in Geriatric Patients

J Am Coll Surg. 2026 Jan 22. doi: 10.1097/XCS.0000000000001791. Online ahead of print.

Authors

Alexis M Holland¹, Mary C Devane², Gregory T Scarola³, William R Lorenz³, Hadley H Wilson³, Sullivan A Ayuso⁴, Kent W Kercher³, Vedra A Augenstein³, B Todd Heniford⁵

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.
² Atrium Health Senior Care, Division of Geriatric Medicine, Department of Family Medicine, Charlotte, North Carolina.
³ Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina.
⁴ Division of Elective General Surgery, Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas.
⁵ Division of Gastrointestinal and General Surgery, Department of Surgery, Endeavor Health, Evanston, Illinois.

PMID: 41568827
DOI: 10.1097/XCS.0000000000001791

Abstract

Background: Chronological age is associated with adverse outcomes after abdominal wall reconstruction (AWR), yet many age-linked risks are modifiable. This study evaluated the benefit of integrating Geriatric Medicine (GM) into a multidisciplinary AWR clinic.

Study design: Using a prospectively maintained database, patients ≥65 years old underwent AWR after a preoperative GM consultation were propensity matched in a 1:1 fashion to (1) patients ≥65 years prior to GM integration (NGM) and (2) younger patients (<65 years). Primary outcomes were hospital length-of-stay (LOS) and 30-day medical and surgical complications.

Results: GM versus NGM: 124 pairs were similar in matching covariates, including age (74.5±6.0vs. 5.7±8.0years;p=0.204). GM patients had higher rates of steroids (17.7%vs.3.2%;p<0.001), ASA class III (73.4%vs.44.4%;p<0.001) but fewer medical complications (4.8%vs.16.1%;p=0.006) and fewer ICU admissions (0.8%vs.5.6%;p=0.066).GM versus NGM ventral hernia subgroup: 62 pairs were similar in matching covariates and hernia complexity. GM patients were more comorbid but had reduced LOS (4.7±2.9vs.6.7±6.5days;p=0.028) and wound complications (3.2%vs.21.0%;p=0.004).GM versus younger: 100 pairs were similar in matching covariates, except for BMI (29.0±4.7vs.31.7±6.2kg/m 2;p=0.002). GM patients were older (73.0±5.0vs.49.5±7.7years;p<0.001), more comorbid (COPD: 12.0%vs.0.0%;p<0.001, steroids: 14.0%vs.5.0%;p=0.030), but comparable in hernia complexity. GM had shorter LOS (4.9±5.4vs.5.8±6.7days;p=0.001). Medical complications, wound complications, reoperations, and readmissions were not statistically different (all p>0.050).

Conclusions: Embedding GM into a multidisciplinary AWR clinic was associated with clinically meaningful reductions in LOS and complications compared to matched older adults without GM and outcomes equal to a matched cohort nearly 25 years younger. Preoperative GM consultation should be considered for complex AWR candidates.

Keywords: Geriatric; abdominal wall reconstruction; frailty; hernia; multidisciplinary; prehabilitation; preoperative; preoptimization.