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Open inguinal hernia repair outcomes in liver transplant recipients versus patients with cirrhosis

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Abstract

Purpose

Patients with liver cirrhosis (LC) are at an increased risk for postoperative complications after open inguinal hernia repair (OIHR). It is possible that orthotopic liver transplant (OLT) recipients may have better outcomes, given reversal of liver failure pathophysiology. Therefore, we sought to compare mortality risk, complications, length of stay (LOS), and cost associated with OIHR in OLT recipients versus LC.

Methods

From the National Inpatient Sample (NIS), using ICD-9 codes, we found 83 OLT recipients and 764 patients with LC who underwent OIHR between 2002 and 2014. We used logistic, negative binomial, and multiple linear regression models to compare peri-operative mortality risk, postoperative complications, and LOS, and cost associated with OIHR in OLT recipients versus LC patients. Models were adjusted for patient demographic and clinical characteristics, and hospital factors.

Results

OLT recipients were younger (58 vs 61, p = 0.02), more likely to be privately insured (42.0% vs 24.6%, p = 0.006), less likely to have ascites at time of surgery (5.1% vs 18.9%, p = 0.003), and have surgery at large (84.3% vs 65.2%, p = 0.01) and teaching hospitals (84.2% vs 47.9%, p < 0.001). There were no mortalities among OLT recipients, but 19 (2.5%) deaths among LC patients. OLT recipients had a similar risk of overall complications (adjusted odds ratio aOR = 0.71 1.30 2.41) and hospital-associated costs (adjusted cost ratio = 0.71 0.88 1.09). However, LOS was significantly different with OLT recipients having shorter LOS (adjusted LOS ratio = 0.56 0.70 0.89).

Conclusion

Delaying OIHR in patients with LC until after OLT decreases LOS and may carry decreased mortality.

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Code availability

Statistical analyses were performed using Stata/IC 15.1 via the authors’ custom code.

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Funding

No author received any funding for this investigation.

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Authors and Affiliations

  1. Division of Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 765, Baltimore, MD, 21205, USA

    N. Siegel, S. DiBrito, T. Ishaque, A. B. Kernodle, A. Cameron, D. Segev & J. Garonzik-Wang

  2. Department of Minimally Invasive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    G. Adrales

Authors
  1. N. Siegel
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  2. S. DiBrito
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  3. T. Ishaque
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  4. A. B. Kernodle
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  5. A. Cameron
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  6. D. Segev
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  7. G. Adrales
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  8. J. Garonzik-Wang
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Corresponding author

Correspondence to J. Garonzik-Wang.

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All the authors declare no conflict of interest with the investigation.

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The Institutional Review Board of Johns Hopkins University reviewed and approved this study.

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This study does not include any animal trial. For this type of article, informed consent is not required.

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All the obtained data were deidentified. All procedures performed in this study were in accordance with the ethical standards of the institutional committee and the HCUP-AHRQ data user agreement.

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Siegel, N., DiBrito, S., Ishaque, T. et al. Open inguinal hernia repair outcomes in liver transplant recipients versus patients with cirrhosis. Hernia 25, 1295–1300 (2021). https://doi.org/10.1007/s10029-020-02290-8

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  • DOI: https://doi.org/10.1007/s10029-020-02290-8

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