Advanced age does not affect abdominal wall reconstruction outcomes using acellular dermal matrix: A comparative study using propensity score analysis

Background We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal wall reconstruction (AWR) for hernia or oncologic resection. Methods We included all consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) between 2005 and 2015. Propensity score analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The primary outcome was hernia recurrence; the secondary outcomes included surgical site occurrence (SSO) and bulging. Results Mean follow-up for the 511 patients was 31.4 months; 184 (36%) patients were elderly. The elderly and non-elderly groups had similar rates of hernia recurrence (7.6% vs 10.1%, respectively; p = 0.43) and SSO (24.5% vs 23.5%, respectively; p = 0.82). Bulging occurred significantly more often in elderly patients (6.5% vs 2.8%, respectively; p = 0.04). After adjustment through the propensity score, which included 130 pairs, these results persisted. Conclusions Contrary to our hypothesis, elderly patients did not have worse outcomes in AWR with ADM. Surgeons should not deny elderly patients AWR solely because of their age.