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Umbilical Hernia Repair in Patients with Cirrhosis and in Patients with Severe Comorbidities—A Nationwide Cohort Study

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Abstract

Introduction

Umbilical hernia is a frequent condition in patients with cirrhosis. The aim of the study was to evaluate the risks associated with umbilical hernia repair in patients with cirrhosis in the elective and emergency setting. Secondly, to compare patients with cirrhosis with a population of patients with equally severe comorbidities but without cirrhosis.

Methods

Patients with cirrhosis who underwent umbilical hernia repair from January 1, 2007, to December 31, 2018, were included from the Danish Hernia Database. A control group of patients with a similar Charlson score (≥ 3) without cirrhosis was generated using propensity score matching. The primary outcome was postoperative re-intervention within 30 days following hernia repair. Secondary outcomes were mortality within 90 days and readmission within 30 days following hernia repair.

Results

A total of 252 patients with cirrhosis and 504 controls were included. Emergency repair in patients with cirrhosis was associated with a significantly increased rate of re-intervention (54/108 (50%) vs. 24/144 (16.7%), P < 0.001), 30-day readmission rate (50/108 (46.3%) compared with elective repair vs. 36/144 (25%) (P < 0.0001)), and 90-day mortality (18/108 (16.7%) vs. 5/144 (3.5%), P < 0.001). Patients with cirrhosis were more likely to undergo a postoperative re-intervention compared with comorbid patients without cirrhosis (OR = 2.10; 95% CI [1.45–3.03]).

Conclusion

Patients with cirrhosis and other severe comorbidity undergo emergency umbilical hernia repair frequently. Emergency repair is associated with increased risk of poor outcome. Patients with cirrhosis undergo a postoperative reintervention more frequently than patients with other severe comorbidity undergoing umbilical hernia repair.

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Funding

The Danish Hernia Database is funded by the Danish Regions funds for clinical databases.

Author information

Authors and Affiliations

  1. Abdominalcenter, University of Copenhagen, Herlev Hospital, 2730, Herlev, Denmark

    Christian Snitkjær & Nadia A. Henriksen

  2. Gastro Unit, Medical Division, University Hospital Hvidovre, Copenhagen, Denmark

    Lise Lotte Gluud & Nina Kimer

  3. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Mette W. Christoffersen & Kristian Kiim Jensen

  4. Zealand University Hospital, Koege, Denmark

    Frederik Helgstrand

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  1. Christian Snitkjær
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  2. Mette W. Christoffersen
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  3. Lise Lotte Gluud
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Correspondence to Christian Snitkjær.

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Snitkjær, C., Christoffersen, M.W., Gluud, L.L. et al. Umbilical Hernia Repair in Patients with Cirrhosis and in Patients with Severe Comorbidities—A Nationwide Cohort Study. World J Surg 47, 2733–2740 (2023). https://doi.org/10.1007/s00268-023-07047-9

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