{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:59:33Z","timestamp":1780394373386,"version":"3.54.1"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K76AG068515"],"award-info":[{"award-number":["K76AG068515"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS02987402"],"award-info":[{"award-number":["R01HS02987402"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32DC009401"],"award-info":[{"award-number":["T32DC009401"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and Setting<\/jats:title>\n                    <jats:p>Key stakeholders involved in inguinal hernia repair at Veterans' Affairs hospital systems including patients, surgeons, anesthesiologists, and hospital leaders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted semi\u2010structured 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\u2010B) framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We interviewed 40 Veterans aged \u2265\u200965\u2009years 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\u2010making conversations about the advantages and disadvantages of local versus general anesthesia because standard pre\u2010operative 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\u2010in from hospital leadership, and more high\u2010quality evidence in support of local anesthesia were all necessary to increase its use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings serve as a roadmap for a multi\u2010component plan to increase use of local anesthesia for inguinal hernia repair in older adults, with clear advantages for post\u2010operative cognitive and functional recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70402","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T12:35:04Z","timestamp":1774528504000},"page":"1348-1357","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Barriers to the Implementation of Local Anesthesia for Older Adults Undergoing Inguinal Hernia Repair"],"prefix":"10.1111","volume":"74","author":[{"given":"Don","family":"Mai","sequence":"first","affiliation":[{"name":"Department of Surgery University of Wisconsin\u2010Madison SMPH  Madison Wisconsin USA"},{"name":"William S. Middleton Memorial VA Hospital  Madison Wisconsin USA"},{"name":"Wisconsin Surgical Outcomes Research Group (WiSOR)  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2035-5496","authenticated-orcid":false,"given":"Benjamin A. Y.","family":"Cher","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Wisconsin\u2010Madison SMPH  Madison Wisconsin USA"},{"name":"Wisconsin Surgical Outcomes Research Group (WiSOR)  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Lunardi","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"VA North Texas Health Care System  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9638-4266","authenticated-orcid":false,"given":"Melissa","family":"Thornton","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"VA North Texas Health Care System  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn G.","family":"Baker","sequence":"additional","affiliation":[{"name":"Qualitative Health Research Consultants  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Peter O'donnell Jr. School of Public Health University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celette Sugg","family":"Skinner","sequence":"additional","affiliation":[{"name":"Peter O'donnell Jr. School of Public Health University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1629-5507","authenticated-orcid":false,"given":"Cynthia J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Louisiana State University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa L.","family":"Marten","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Wisconsin\u2010Madison SMPH  Madison Wisconsin USA"},{"name":"William S. Middleton Memorial VA Hospital  Madison Wisconsin USA"},{"name":"Wisconsin Surgical Outcomes Research Group (WiSOR)  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Makris","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine  Houston Texas USA"},{"name":"Michael E. DeBakey Veterans Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa Machado","family":"Heredia","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine  Houston Texas USA"},{"name":"Michael E. DeBakey Veterans Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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Middleton Memorial VA Hospital  Madison Wisconsin USA"},{"name":"Wisconsin Surgical Outcomes Research Group (WiSOR)  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"The U.S. Joins Other Countries With Large Aging Populations","author":"Bureau UC","year":"2018"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40137\u2010016\u20100140\u20107"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010016\u20100329\u20108"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2014.1819"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2014.09.021"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2020.08.024"},{"key":"e_1_2_10_8_1","unstructured":"\u201cOptimal Perioperative Management of the Geriatric Patient \u201daccessed August 27 2025 https:\/\/www.facs.org\/media\/y5efmgox\/acs\u2010nsqip\u2010geriatric\u20102016\u2010guidelines.pdf."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.06.024"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(03)14339\u20105"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5543"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.SLA.0000059992.76731.64"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481207800721"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029\u2010021\u201002532\u20103"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u20105908\u20106\u201042"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744987117741667"},{"key":"e_1_2_10_19_1","volume-title":"NVivo: Leading Qualitative Data Analysis Software","year":"2025"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004735"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.6616"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70402","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.70402","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:17:54Z","timestamp":1780031874000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.70402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/jgs.70402"],"URL":"https:\/\/doi.org\/10.1111\/jgs.70402","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"assertion":[{"value":"2025-11-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}