Journal of Gastrointestinal Surgery

, Volume 12, Issue 4, pp 675–681

Umbilical Herniorrhapy in Cirrhosis: Improved Outcomes with Elective Repair

  • Stephen H. Gray
  • Catherine C. Vick
  • Laura A. Graham
  • Kelly R. Finan
  • Leigh A. Neumayer
  • Mary T. Hawn
ssat plenery presentation

DOI: 10.1007/s11605-008-0496-9

Cite this article as:
Gray, S.H., Vick, C.C., Graham, L.A. et al. J Gastrointest Surg (2008) 12: 675. doi:10.1007/s11605-008-0496-9

Abstract

Objective

This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes.

Methods

Procedures were identified from the Veterans’ Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical records and operative reports were physician abstracted to obtain preoperative and intraoperative variables.

Results

Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%, p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant predictors of complications were emergent case (OR 5.4; 95% CI 3.1–9.4), diabetes (OR 2.1; 95% CI 1.2–3.8), congestive heart failure (OR 4.0; 95% CI 1.4–11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1–3.6). Among emergent repairs, cirrhosis (OR 4.4; 95% CI 1.3–14.3) was strongly associated with postoperative complications.

Conclusion

Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis.

Keywords

Umbilical herniaOutcomesCirrhosisCase status

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Stephen H. Gray
    • 1
    • 2
    • 3
  • Catherine C. Vick
    • 1
    • 2
  • Laura A. Graham
    • 1
  • Kelly R. Finan
    • 1
    • 2
  • Leigh A. Neumayer
    • 4
  • Mary T. Hawn
    • 1
    • 2
  1. 1.Deep South Center for Effectiveness ResearchBirmingham Veterans Affairs (VA) Medical CenterBirminghamUSA
  2. 2.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Health Services and Outcomes Research Training Program, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.VA Medical Center and Department of SurgeryUniversity of UtahSalt Lake CityUSA