Critical differences among stakeholders in definitions of success following inguinal hernia repair in older adults

Authors

• Melissa Thornton, University of Texas Southwestern Medical Center, Dallas, TX
• Benjamin A. Cher, William S. Middleton Memorial VA Hospital, Madison, WI
• Cameron Macdonald, Qualitative Healthcare Research Consultants, LLC, Madison, WI
• Nicole Lunardi, University of Texas Southwestern Medical Center, Dallas, TX
• Elisa L. Marten, William S. Middleton Memorial VA Hospital, Madison, WI
• Don Mai, William S. Middleton Memorial VA Hospital, Madison, WI
• Kacy Fisher, Qualitative Healthcare Research Consultants, LLC, Madison, WI
• Maria Luisa Machado Heredia, Baylor College of Medicine, Houston, TX
• Celette Sugg Skinner, University of Texas Southwestern Medical Center, Dallas, TX
• Cynthia J. Brown, LSU Health Sciences Center - New OrleansFollow
• Miles Berger, Duke University Medical Center, Durham, NC
• Simon Craddock Lee, University of Kansas Medical Center, Kansas City, KS
• C Munro Cullum, University of Texas Southwestern Medical Center, Dallas, TX
• Konstantinos I. Makris, Baylor College of Medicine, Houston, TX
• Thai H. Pham, University of Texas Southwestern Medical Center, Dallas, TX
• Victoria Tang, University of Texas Health Science Center, Houston, TX
• Aanand D. Naik, University of Texas Health Science Center, Houston, TX
• Courtney J. Balentine, William S. Middleton Memorial VA Hospital, Madison, WI

Document Type

Article

Publication Date

4-20-2026

Publication Title

Surgery

Abstract

BACKGROUND: Inguinal hernia repair is one of the most common elective operations performed in adults aged 65 years and older, but there is little information on how different groups of stakeholders define successful inguinal hernia repair. The purpose of this study was to compare how older veterans, surgeons, anesthesiologists, and Veterans Affairs leadership define success after inguinal hernia surgery. METHODS: Semistructured interviews and focus groups explored the relative importance of several hernia-related outcomes with 40 veterans aged ≥65 years who recently underwent inguinal hernia repair, 10 surgeons, 9 anesthesiologists, and 7 Veterans Affairs hospital leaders. RESULTS: The mean age of veteran participants was 73 years. All were male, 65% were White, and 33% were Black. Surgeons, anesthesiologists, and hospital leaders were 69% male. For veterans, the 3 most important outcomes defining successful hernia surgery were avoiding postoperative urinary retention, returning to normal physical function within 2 months of surgery, and minimizing cognitive dysfunction. For surgeons, the most important outcomes were returning to normal within 2 months after surgery, avoiding inguinodynia, and minimizing cognitive dysfunction. For anesthesiologists, the most important outcomes were returning to normal by 2 months, avoiding cognitive dysfunction, and preventing intraoperative pain. Hospital leaders agreed that normalization within 2 months and avoiding cognitive dysfunction were important, but they also considered readmission a critical outcome. CONCLUSION: Surgery is only efficacious, cost effective, and ethical when it delivers outcomes that are important to patients. Discordance among patients, providers, and health systems can lead to miscommunication, ineffective or wasteful care, and poor outcomes.

First Page

1

Last Page

9

PubMed ID

42208472

Volume

196

Rights

© 2026 Published by Elsevier Inc.

Recommended Citation

Thornton, Melissa; Cher, Benjamin A.; Macdonald, Cameron; Lunardi, Nicole; Marten, Elisa L.; Mai, Don; Fisher, Kacy; Machado Heredia, Maria Luisa; Skinner, Celette Sugg; Brown, Cynthia J.; Berger, Miles; Lee, Simon Craddock; Cullum, C Munro; Makris, Konstantinos I.; Pham, Thai H.; Tang, Victoria; Naik, Aanand D.; and Balentine, Courtney J., "Critical differences among stakeholders in definitions of success following inguinal hernia repair in older adults" (2026). School of Medicine Faculty Publications. 4750.
https://digitalscholar.lsuhsc.edu/som_facpubs/4750
10.1016/j.surg.2026.110253