Abstract
Purpose
The aim of this project was to compare patient characteristics, overall efficacy, and readmission events following operative vs non-operative management modalities of non-elective patients presenting with symptomatic incisional hernias.
Methods
This study is a retrospective study of patients and patient demographics that presented as non-elective hospitalizations with symptomatic incisional hernia. Analysis of patients and characteristics utilized the National Readmission Database from 2010 to Q3 of 2015, delineating patient factors and outcomes following operative or non-operative management of hernias.
Results
A total of 14,137 patients met inclusion criteria for our study. The majority of patients were treated operatively rather than non-operatively (79 vs. 21%) on their non-elective admission for incisional hernia. Those undergoing surgical management were younger (56 vs 61 years, p < 0.01), we more often of male gender (69 vs 64%, p < 0.01), and had fewer comorbidities (1.92 vs 2.97, p < 0.01) and chronic conditions (0.45 vs 2.68, p < 0.01). Patients managed operatively had a significantly lower readmission rate when compared to patients managed non-operatively (6.6 vs 14.3%, p < 0.01). However, non-operative management was associated with a shorter length of stay (3 vs 4 days, p < 0.01). Of patients who were initially medically managed and had to be readmitted, a further 61% underwent surgical treatment on their readmission.
Conclusion
In this nationwide study, patients with non-elective admissions for incisional hernia were mostly managed surgically. Those managed operatively had lower rates of readmission when compared to non-operative management. Initial non-operative management was associated with a shorter length of stay and a lower cost to the patient. The results of this study support operative management of symptomatic incisional hernia.
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References
Hope WW, Faiz T. (2018) “Incisional hernia.” Statpearls, US national library of medicine, www.ncbi.nlm.nih.gov/books/NBK435995/. 13 Dec 2018
Sanders DL, Kingsnorth AN (2012) The modern management of incisional hernias. Br Med J (BMJ) 344:9. https://doi.org/10.1136/bmj.e2843
Poulose BK et al (2011) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183. https://doi.org/10.1007/s10029-011-0879-9
Holihan JL, Henchcliffe BE, Mo J, Flores-Gonzalez JR, Ko TC, Kao LS, Liang MK (2016) Is nonoperative management warranted in ventral hernia patients with comorbidities?: A case-matched, prospective patient-centered study. Ann Surg 264(4):585–590. https://doi.org/10.1097/SLA.0000000000001865 (PMID: 27355269)
Bernardi K, Martin AC, Holihan JL, Olavarria OA, Flores-Gonzalez JR, Cherla DV, Lyons NB, Shah P, Kao LS, Ko TC, Liang MK (2019) Is non-operative management warranted in ventral hernia patients with comorbidities? A case-matched, prospective 3 year follow-up, patient-centered study. Am J Surg 218(6):1234–1238. https://doi.org/10.1016/j.amjsurg.2019.07.044 (Epub 2019 Aug 7 PMID: 31421893)
Jensen KK, Erichsen R, Krarup PM (2017) The impact of incisional hernia on mortality after colonic cancer resection. Surg Endosc 31(5):2149–2154. https://doi.org/10.1007/s00464-016-5212-3 (Epub 2016 Sep 7 PMID: 27604372)
Jensen KK, Arnesen RB, Christensen JK, Bisgaard T, Jørgensen LN (2019) Large incisional hernias increase in size. J Surg Res. 244:160–165. https://doi.org/10.1016/j.jss.2019.06.016 (Epub 2019 Jul 8. Erratum in: J Surg Res. 2022 Jan;269:142-143. PMID: 31295649)
Wolf LL et al (2019) Management of reducible ventral hernias. Ann Surg 269(2):358–366. https://doi.org/10.1097/sla.0000000000002507
Verhelst J, Timmermans L, van de Velde M, Jairam A, Vakalopoulos KA, Jeekel J, Lange JF (2015) Watchful waiting in incisional hernia: is it safe? Surgery 157(2):297–303. https://doi.org/10.1016/j.surg.2014.09.017 (PMID: 25616943)
Burger JWA et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585
Abi-Haidar Y et al. (2011) Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg www.journalacs.org/article/S1072-7515(11)00372-3/fulltext
Hoffman RD, Danos DM, Lau FH (2021) National health disparities in incisional hernia repair outcomes: an analysis of the healthcare cost and utilization project national inpatient sample (HCUP-NIS) 2012–2014. Surgery 169(6):1393–1399. https://doi.org/10.1016/j.surg.2020.11.028
Rios-Diaz AJ, Cunning JR, Broach RB et al (2020) One-year health care utilization and recurrence after incisional hernia repair in the united states: a population-based study using the nationwide readmission database. J Surg Res 255:267–276. https://doi.org/10.1016/j.jss.2020.03.070
Huckaby LV, Dadashzadeh ER, Handzel R, Kacin A, Rosengart MR, van der Windt DJ (2020) Improved understanding of acute incisional hernia incarceration: implications for addressing the excess mortality of emergent repair. J Am Coll Surg 231(5):536-545.e4. https://doi.org/10.1016/j.jamcollsurg.2020.08.735
Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Bisgaard T (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 216(2):217–228. https://doi.org/10.1016/j.jamcollsurg.2012.10.013
Sørensen LT, Malaki A, Wille-Jørgensen P et al (2007) Risk Factors for mortality and postoperative complications after gastrointestinal surgery. J Gastrointest Surg 11:903–910. https://doi.org/10.1007/s11605-007-0165-4
Cameron JL (2019) Current surgical therapy, 13th edn. Elsevier Mosby, Philadelphia, pp 651–652
Drolshagen H, Bhavaraju A, Kalkwarf KJ et al (2021) Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the nationwide readmissions database [published correction appears in Hernia]. Hernia 25(5):1259–1264. https://doi.org/10.1007/s10029-021-02441-5
Sneiders D, Yurtkap Y, Kroese LF et al (2019) Risk factors for Incarceration in patients with primary abdominal wall and incisional hernias: a prospective study in 4472 patients. World J Surg 43:1906–1913. https://doi.org/10.1007/s00268-019-04989-x
Kroese LF, Gillion JF, Jeekel J, Kleinrensink GJ, Lange JF (2018) Hernia-club members primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications—a prospective cohort study of 4565 patients. Int J Surg 51:114–119. https://doi.org/10.1016/j.ijsu.2018.01.010
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This research did not receive any specific grant or funding in the public, commercial, or non-profit sectors.
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KWS conceived of the presented idea. KWS, RR, and SK verified the analytical methods. RR and SK performed the analytic calculations. HKJ facilitated the process along the way with guidance in analysis. GTR, JN, and DJW drafted the manuscript. All authors discussed the results and commented on the final manuscript.
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Nigh, J., Wade, D.J., Rives, G.T. et al. Operative management of non-elective incisional hernia reduces readmission in a national database. Hernia 27, 541–547 (2023). https://doi.org/10.1007/s10029-022-02643-5
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DOI: https://doi.org/10.1007/s10029-022-02643-5