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Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement

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Abstract

Purpose

The precise importance of factors affecting morbidity and mortality in patients with complicated abdominal wall hernias undergoing emergency surgical repair has been not completely elucidated.

Patients and methods

A retrospective multicentric study of all patients (n = 402) with abdominal wall hernia who underwent urgent operations over 1-year period was conducted in ten hospitals. Logistic regression analysis was used to evaluate variables that affect morbidity and mortality.

Results

Thirty-five percent of patients had inguinal hernia, 22% femoral hernia, 20% umbilical hernia, and 15% incisional hernia. Mesh repair was used in 92.5% of cases. Intestinal resection was required in 49 patients. Perioperative complications occurred in 130 patients, and 18 patients died (mortality rate 4.5%). Complications and mortality rate were significantly higher in the group of intestinal resection. Patients older than 70 years also showed more complications, required intestinal resection more frequently, and had a higher mortality rate than younger patients. In the logistic regression analysis, age over 70 years, intestinal resection, and American Society of Anesthesiologists (ASA) III/IV class emerged as independent predictors of a poor outcome. Based in our results, we propose a simple schema to calculate risk of death in these patients.

Conclusion

Using multivariate logistic regression analysis, probabilities of death after complicated abdominal wall hernia surgery are increased in patients with: age over 70 years, high ASA class, and associated intestinal resection. Guidelines should be developed to improve prognosis in these patients.

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References

  1. Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25:835–839

    Article  CAS  PubMed  Google Scholar 

  2. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571

    Article  PubMed  Google Scholar 

  3. Mensching JJ, Musielewicz AJ (1996) Abdominal wall hernias. Emerg Clin North Am 14:739–756

    Article  CAS  Google Scholar 

  4. Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Heidemann Andersen F, Wara P, Juul P, Callesen T (2001) Quality assessment on 26 304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128

    Article  CAS  PubMed  Google Scholar 

  5. O'Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P (2006) Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg 244:167–173

    Article  PubMed  Google Scholar 

  6. Rodríguez-Cuéllar E, Villeta R, Ruiz P, Alcalde J, Landa JI, Luis Porrero J, Gómez M, Jaurrieta E (2005) National project for the management of clinical processes. Surgical treatment of inguinal hernia. Cir Esp 77:195–202

    Google Scholar 

  7. Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O'Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87:1722–1726

    Article  CAS  PubMed  Google Scholar 

  8. McGugan E, Burton H, Nixon SJ, Thompson AM (2000) Deaths following hernia surgery: room for improvement. J R Coll Surg Edinb 45:183–186

    CAS  PubMed  Google Scholar 

  9. Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, Coskun F (2001) Presentation and outcome of incarcerated external hernias in adults. Am J Surg 181:101–104

    Article  CAS  PubMed  Google Scholar 

  10. Alvarez JA, Baldonedo RF, Bear IG, Solís JA, Alvarez P, Jorge JI (2005) Incarcerated groin hernias in adults: presentation and outcome. Cir Esp 77:40–45

    Article  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  12. Derici H, Unalp HR, Bozdag AD, Nazli O, Tansug T, Kamer E (2007) Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia 11:341–346

    Article  CAS  PubMed  Google Scholar 

  13. Kurt N, Oncel M, Ozkan Z, Bingul S (2003) Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 27:741–743

    Article  PubMed  Google Scholar 

  14. Malek S, Torella F, Edwards PR (2004) Emergency repair of groin herniae: outcome and implications for elective surgery waiting times. Int J Clin Pract 58:207–209

    Article  CAS  PubMed  Google Scholar 

  15. Nilsson H, Stylianidis G, Haapamäki M, Nilsson E, Nordin P (2007) Mortality after groin hernia surgery. Ann Surg 245:656–660

    Article  PubMed  Google Scholar 

  16. Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F (2001) Emergency hernia repairs in elderly patients. Am J Surg 182:455–459

    Article  CAS  PubMed  Google Scholar 

  17. Nehme AE (1983) Groin hernias in elderly patients. Management and prognosis. Am J Surg 146:257–260

    Article  CAS  PubMed  Google Scholar 

  18. Tingwald GR, Cooperman M (1982) Inguinal and femoral hernia repair in geriatric patients. Surg Gynecol Obstet 154:704–706

    CAS  PubMed  Google Scholar 

  19. Ohana G, Manevwitch I, Weil R, Melki Y, Seror D, Powsner E, Dreznik Z (2004) Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients. Hernia 8:117–120

    Article  PubMed  Google Scholar 

  20. Constantinides VA, Tekkis PP, Senapati A (2006) Prospective multicenter evaluation of adverse outcomes following treatment for complicated diverticular disease. Br J Surg 93:1503–1513

    Article  CAS  PubMed  Google Scholar 

  21. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JS, Hoehn JL, Murphy JT, Sarosi GA Jr, Syme WC, Thompson JS, Wang J, Jonasson O (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 295:285–292

    Article  CAS  PubMed  Google Scholar 

  22. Owens CD, Stoessel K (2008) Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect 70(S2):3–10

    Article  PubMed  Google Scholar 

  23. Ferzli G, Shapuiro K, Chaudry G, Patel S (2004) Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia. Surg Endosc 18:228–231

    Article  CAS  PubMed  Google Scholar 

  24. Rebuffat C, Galli A, Scalambra MS, Balsamo F (2006) Laparoscopic repair of strangulated hernias. Surg Endosc 20:131–134

    Article  CAS  PubMed  Google Scholar 

  25. Legnani GL, Rasini M, Pastori S, Sarli D (2008) Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguinocrural hernias: a report of nine cases. Hernia 12:185–188

    Article  CAS  PubMed  Google Scholar 

  26. Ng A, Smith G (2001) Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg 93:494–513

    Article  CAS  PubMed  Google Scholar 

  27. Walsh SR, Tang TY, Farooq N, Coveney E, Gaunt M (2008) Perioperative fluid restriction reduces complication after major gastrointestinal surgery. Surgery 143:466–468

    Article  PubMed  Google Scholar 

  28. Qaseem A, Snow V, Fitterman N, Hornbake R, Lawrence V, Smetana G, Weiss K, Owens D (2006) Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from American College of Physicians. Ann Intern Med 144:575–580

    PubMed  Google Scholar 

  29. Lawrence V, Cornell JE, Smetana GW (2006) Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: Systematic Review for the American College of Physicians. Ann Intern Med 144:596–608

    PubMed  Google Scholar 

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Acknowledgements

The authors thank Dr. Marta Pulido for editing the manuscript and editorial assistance.

Conflict of interest

None

Author information

Authors and Affiliations

  1. Department of General and Digestive Surgery, Hospital Universitari del Mar, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain

    M. Ángeles Martínez-Serrano, José A. Pereira & Juan J. Sancho

  2. Department of Health and Experimental Sciences, Pompeu Fabra University, Barcelona, Spain

    José A. Pereira

  3. Department of General Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Manuel López-Cano

  4. Service of General Surgery, Consorci Sanitari del Maresme, Mataró, Spain

    Ernest Bombuy

  5. Service of General Surgery, Hospital Parc Tauli, Sabadell, Spain

    José Hidalgo

Authors
  1. M. Ángeles Martínez-Serrano
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  2. José A. Pereira
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  3. Juan J. Sancho
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  4. Manuel López-Cano
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  5. Ernest Bombuy
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  6. José Hidalgo
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Consortia

the Study Group of Abdominal Hernia Surgery of the Catalan Society of Surgery

Corresponding author

Correspondence to José A. Pereira.

Additional information

Study Group of Abdominal Hernia Surgery of the Catalan Society of Surgery: Jaime Jimeno, María de los Ángeles Martínez-Serrano, José A. Pereira, Juan J. Sancho, and Luis Grande (Hospital Universitari del Mar, Barcelona); Meritxell Girvent (Department of Health and Experimental Sciences, Pompeu Fabra University, Barcelona); Ramón Vilallonga, Roberto Lozoya, and Manuel López-Cano (Hospital Vall d’Hebron, Barcelona); Ernest Bombuy (Consorci Sanitari del Maresme, Mataró, Barcelona); Susana Ros (Hospital Universitari Arnau de Vilanova, Lleida); Francesc Marsal (Hospital de Sant Pau i Santa Tecla, Tarragona); Francisco Martínez-Ródenas; Llucia Catot (Hospital Municipal de Badalona, Badalona, Barcelona); Dolors Güell (Hospital de Terrassa, Terrassa, Barcelona); José Hidalgo and Gabriel Cánovas (Hospital Parc Taulí, Sabadell, Barcelona); Carles Ribera (Hospital Sant Joan de Deu, Martorell, Barcelona); and Miquel Casal (Hospital de Granollers, Granollers, Barcelona).

Sources of financial support: Grant of Fundació Avedis Donabedian. Departament de Salut. Generalitat de Catalunya.

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Martínez-Serrano, M.Á., Pereira, J.A., Sancho, J.J. et al. Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg 395, 551–556 (2010). https://doi.org/10.1007/s00423-009-0515-7

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  • DOI: https://doi.org/10.1007/s00423-009-0515-7

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