Age and Complicated Presentation in Adult Femoral Hernia: A Cross-Sectional Analysis of a 12-Year Surgical Case Series From a Colombian Referral Center

Background Femoral hernias are uncommon but disproportionately morbid because of their propensity to incarceration and strangulation. Characteristics accompanying a complicated presentation are poorly defined, and Latin American data are scarce. Methods This is a cross-sectional analysis of a single-center retrospective case series of consecutive adults undergoing surgery for intraoperatively confirmed femoral hernia at a Colombian referral center (2013-2024). The outcome, complicated (incarcerated/strangulated) vs reducible presentation, was established at operation, not followed over time; analyses are exploratory. Associations were estimated with Firth penalized logistic regression, with restricted cubic splines for non-linearity; reporting followed STROBE. Results Of 64 operated patients (79.7% women; median age 74), 41 (64.1%) had a complicated hernia at operation. Complicated cases were older (median: 82 vs 63 years; P < 0.001), with more comorbidity and higher ASA class. Age was the only characteristic independently associated with complicated presentation (adjusted odds ratio per 10-year increase: 3.29; 95% CI, 1.75-7.33); the gradient was monotonic, and age alone discriminated as well as the three-variable model (area under the curve: 0.85 vs 0.86). Intervals were wide, reflecting the small sample. Complicated presentation was accompanied by bowel resection (24.4% vs 0%), postoperative morbidity (36.6% vs 4.3%; P = 0.006), longer stay, and the only death. Discussion Older age was the characteristic most strongly associated with incarceration or strangulation at operation. Because eligibility required surgery and the outcome was ascertained at that operation, these are associations within a surgically selected series; they cannot establish prospective prediction, causation, or progression from a reducible to a complicated hernia, and are hypothesis-generating.