Barriers to the Implementation of Local Anesthesia for Older Adults Undergoing Inguinal Hernia Repair

Authors

• Don Mai, Department of Surgery, University of Wisconsin-Madison SMPH, Madison, Wisconsin, USA.
• Benjamin A. Cher, Department of Surgery, University of Wisconsin-Madison SMPH, Madison, Wisconsin, USA.
• Nicole Lunardi, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Melissa Thornton, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Jocelyn G. Baker, Qualitative Health Research Consultants, Madison, Wisconsin, USA.
• Cameron Macdonald, Peter O'donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Celette Sugg Skinner, Peter O'donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Cynthia J. Brown, LSU Health Sciences Center - New OrleansFollow
• Elisa L. Marten, Department of Surgery, University of Wisconsin-Madison SMPH, Madison, Wisconsin, USA.
• Konstantinos Makris, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
• Maria Luisa Heredia, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
• Miles Berger, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
• C Munro Cullum, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Simon Lee, Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA.
• Thai H. Pham, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Courtney J. Balentine, Department of Surgery, University of Wisconsin-Madison SMPH, Madison, Wisconsin, USA.

Document Type

Article

Publication Date

3-26-2026

Publication Title

Journal of the American Geriatrics Society

Abstract

BACKGROUND: Use of local anesthesia for inguinal hernia repair in older adults is recommended by society guidelines because of reduced postoperative cognitive dysfunction and improved functional recovery after surgery compared to general anesthesia. However, in practice, few inguinal hernia repairs in older adults are actually done under local anesthesia. PARTICIPANTS AND SETTING: Key stakeholders involved in inguinal hernia repair at Veterans' Affairs hospital systems including patients, surgeons, anesthesiologists, and hospital leaders. METHODS: We conducted semi-structured interviews and focus groups to identify barriers and facilitators to use of local anesthesia for inguinal hernia repair in older adults. Qualitative data were analyzed using Direct Content Analysis guided by the Capability, Opportunity, and Motivation (COM-B) framework. RESULTS: We interviewed 40 Veterans aged ≥ 65 years who had undergone inguinal hernia repair at 3 hospitals, and we convened focus groups and interviews with 10 surgeons, 9 anesthesiologists, and 7 hospital leaders. We found patients were not consistently offered the opportunity to have shared decision-making conversations about the advantages and disadvantages of local versus general anesthesia because standard pre-operative care workflows did not allow for conversations incorporating perspectives of all stakeholders, especially anesthesiologists. Also, it was difficult to disentangle choice of anesthesia modality from choice of surgical approach. There were entrenched opinions among many surgeons about perceived advantages of minimally invasive surgery, which requires general anesthesia, without regard for the cognitive and recovery benefits of open surgery using local anesthesia. Finally, providers and hospital leaders highlighted how improved protocols for local anesthesia administration, increased buy-in from hospital leadership, and more high-quality evidence in support of local anesthesia were all necessary to increase its use. CONCLUSIONS: The findings serve as a roadmap for a multi-component plan to increase use of local anesthesia for inguinal hernia repair in older adults, with clear advantages for post-operative cognitive and functional recovery.

PubMed ID

41885347

Publisher

Wiley

Rights

© 2026 The American Geriatrics Society.

Recommended Citation

Mai, Don; Cher, Benjamin A.; Lunardi, Nicole; Thornton, Melissa; Baker, Jocelyn G.; Macdonald, Cameron; Skinner, Celette Sugg; Brown, Cynthia J.; Marten, Elisa L.; Makris, Konstantinos; Heredia, Maria Luisa; Berger, Miles; Cullum, C Munro; Lee, Simon; Pham, Thai H.; and Balentine, Courtney J., "Barriers to the Implementation of Local Anesthesia for Older Adults Undergoing Inguinal Hernia Repair" (2026). School of Medicine Faculty Publications. 4647.
https://digitalscholar.lsuhsc.edu/som_facpubs/4647
10.1111/jgs.70402