David M Pechman, MD, MBA, Lifen Cao, MD, PhD, Carmen Fong, MD, Paul Thodiyil, MD, Burton Surick, MD. Mount Sinai Beth Israel
Introduction: Laparoscopic ventral hernia repair (VHR) is associated with decreased morbidity and shorter length of stay (LOS) when compared to open VHR. Despite evidence of the benefits of laparoscopy, its utilization in VHR has lagged behind that of other complex surgical procedures. We hypothesized that utilization is further reduced in emergency cases. The aim of this study was to evaluate the utilization of laparoscopy in emergent VHR and to assess 30-day outcomes for patients undergoing laparoscopic emergent ventral hernia repair (LEVHR) versus open emergent ventral hernia repair (OEVHR).
Methods: We used the ACS-NSQIP database for 2012 and 2013 to compare LEVHR versus OEVHR. Inclusion required two factors: 1) classification as an emergency case and 2) primary procedure documented as laparoscopic or open repair of incarcerated umbilical, ventral, or incisional hernia. LOS and 30-day morbidity and mortality were assessed. Statistical analyses were performed using two-tailed t-test, Chi-square test, or Fischer exact test.
Results: A total of 13,126 patients underwent emergent repair of initial or recurrent umbilical, ventral, or incisional hernia. 1130 /13,126 (8.6 %) underwent LEVHR repair and 11,996 / 13,126 (91.4 %) underwent OEVHR. Overall patient demographics and comorbid conditions were similar between the groups, however the data displayed a trend towards decreased utilization of laparoscopy in patients with more significant comorbidities. Operative time was longer for LEVHR (94.8 vs 81.6 minutes, p < 0.01). LEVHR was associated with decreased superficial surgical site infection (2.3% vs 4.6%, p < 0.01), deep surgical site infection (0.5% vs 1.6%, p < 0.01), decreased 30-day mortality (1.2% vs 2.4%, p = 0.01), and shorter postoperative LOS (3.5 vs. 4.9 days from OR to discharge, p < 0.01). These associations persisted when subgroup analysis performed for ASA classes 1, 2, 3, and 4; subgroup analysis was not possible for ASA class 5 because all ASA 5 patients underwent OEVHR (n=31).
Conclusion: Utilization of laparoscopy in VHR is low in emergency cases. Patients who did undergo LEVHR had decreased postoperative length of stay, decreased rates of surgical site infection, and lower 30-day mortality. Increased utilization in emergency VHR could significantly improve patient outcomes. Further study is warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88622
Program Number: S012
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium