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Causes of prolonged hospitalization after open incisional hernia repair: an observational single-center retrospective study of a prospective database

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Abstract

Purpose

Enhanced recovery after surgery (ERAS) is a well-known approach to optimize the recovery after surgery. Little is known about specific causes of prolonged hospitalization despite enhanced recovery after open incisional hernia repair (OIHR). The purpose of this study was to identify the causes of continued hospitalization on each of the first 5 postoperative days (PODs) after OIHR.

Methods

This was a retrospective study of consecutive patients undergoing open AWR at a regional academic hernia center from 2008 to 2018. Patient charts were evaluated using predefined potential causes of continued hospitalization on each of the first five PODs.

Results

A total of 388 patients (mean age 60.9 years, 54.6% male, mean BMI 27.9 kg/m2) were included in the study. Mesh placement was either preperitoneal/intraperitoneal (20%) or retromuscular (80%) and 61% of the patients had an epidural catheter. The median length of stay (LOS) in the cohort was four [IQR 2–6] days. On PODs 4 and 5, causes of continued hospital stay were absent bowel function (2% on POD 4, 1% on POD 5), pain (7% on POD 3, 2% on POD 4), lack of mobilization (1% on POD 4, 1% on POD 5), and other causes (urinary retention, high drain output, and complications to the surgery).

Conclusion

Causes for prolonged hospitalization after OIHR were possibly reducible. Future efforts to improve the ERAS regime and reduce LOS after OIHR should focus on pain treatment- and prevention, alternatives to epidural treatment, and well-defined, evidence-based discharge criteria.

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Data availability

Due to Danish law, the data are not available.

Code availability

The code for analysis is not available.

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Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NW, Denmark

    D. M. Skovgaards, H. M. H. Diab, H. G. Midtgaard, L. N. Jørgensen & K. K. Jensen

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  1. D. M. Skovgaards
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  2. H. M. H. Diab
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  3. H. G. Midtgaard
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  4. L. N. Jørgensen
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  5. K. K. Jensen
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Correspondence to D. M. Skovgaards.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Skovgaards, D.M., Diab, H.M.H., Midtgaard, H.G. et al. Causes of prolonged hospitalization after open incisional hernia repair: an observational single-center retrospective study of a prospective database. Hernia 25, 1027–1034 (2021). https://doi.org/10.1007/s10029-020-02353-w

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  • DOI: https://doi.org/10.1007/s10029-020-02353-w

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