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Hernia

, Volume 23, Issue 5, pp 979–985 | Cite as

Predictors of mortality after elective ventral hernia repair: an analysis of national inpatient sample

  • Zhamak KhorgamiEmail author
  • Benedict Y. Hui
  • Nasir Mushtaq
  • Geoffrey S. Chow
  • Guido M. Sclabas
Original Article

Abstract

Purpose

Deciding between surgery and non-operative management of a non-obstructive ventral hernia (VH) in a high-risk patient often poses a clinical challenge. The aim of this study is to evaluate a national series of open and laparoscopic ventral hernia repair (VHR), and to assess predictors of mortality after elective VHR.

Methods

A retrospective analysis of 2008–2014 data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample was performed. All patients with a primary diagnosis of abdominal wall hernia were included. Inguinal, femoral, or diaphragmatic hernias were excluded. Patients were stratified by elective versus emergent repair. Factors associated with mortality after elective VHR were analyzed.

Results

103,635 patients were studied, including 14,787 (14.3%) umbilical, 63,685 (61.5%) incisional, and 25,163 (24.3%) other ventral hernias. Operative procedures included 59,993 (57.9%) elective and 43,642 (42.1%) emergent VHR. 21.3% elective VHRs were laparoscopic versus 13% in emergent cases (P < 0.001). Mesh was used in 52,642 (87.7%) elective versus 27,734 (63.5%) emergent VHR (P < 0.001). Median (interquartile range) length of stay was 2(3) days in laparoscopic and 3(3) days in open group (P < 0.001). Mortality was 0.2% (n = 135) in elective and 0.6% (n = 269) in emergent group (P < 0.001). In elective group, mortality rates were equal among laparoscopic and open VHR (0.2%), while in emergent group, it was lower in laparoscopic VHR (0.4% vs 0.6%, P = 0.028). Multivariate analysis of elective VHR showed that the following factors were associated with mortality during hospitalization: age > 50 years [Odds ratio (OR) = 1.96], male gender (OR = 2.37), congestive heart failure (OR = 2.15), pulmonary circulation disorders (OR = 5.26), coagulopathy (OR = 3.93), liver disease (OR = 1.89), fluid and electrolyte disturbances (OR = 8.66), metastatic cancer (OR = 4.66), neurological disorders (OR = 2.31), and paralysis (OR = 5.29).

Conclusions

VHR has a low mortality, especially when performed laparoscopically. In patients undergoing elective VHR, higher age and some comorbidities are predictors of mortality. These include congestive heart failure, pulmonary circulation disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders, and paralysis. Conservative management should be considered for these high-risk subgroups in context of the overall clinical presentation.

Keywords

Abdominal wall hernia Ventral hernia repair Incisional hernia Laparoscopic Mortality 

Notes

Funding

No specific funds were used for the completion of this study.

Compliance with ethical standards

Conflict of interest

ZK, BH, NM, GSC, and GMS have no conflicts of interest or financial ties to disclose.

Ethical approval

The Institutional Review Board of the University of Oklahoma – Tulsa, reviewed and approved this study.

Human and animal rights

No human participant was directly involved in the study. All the obtained data was de-identified. All procedures performed in this study was in accordance with the ethical standards of the institutional committee and the HCUP-AHRQ data user agreement.

Informed consent

For this study, formal consent was not required.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, College of MedicineUniversity of OklahomaTulsaUSA
  2. 2.Department of Biostatistics and EpidemiologyUniversity of Oklahoma Health Sciences CenterTulsaUSA

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