Zhamak Khorgami, MD, Benedict Y Hui, MD, Guido M Sclabas, MD. University of Oklahoma – Tulsa
Introduction: Ventral hernia (VH) is a common surgical problem and can present both as emergent and elective cases. Deciding between surgery and non-operative management of a non-obstructive VH in a high-risk patient can sometimes be a challenge. The aim of this study was to evaluate national series of open and laparoscopic ventral hernia repair (VHR), and to assess factors associated with mortality after elective VHR.
Method: In a retrospective analysis of 2008-2014 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS), we included all patients with the main diagnosis of abdominal cavity hernia (except inguinal, femoral, and diaphragmatic), and a Diagnosis Related Group (DRG) code related to hernia procedures except inguinal and femoral. Elective and Laparoscopic VHR were identified. Factors associated with the same hospitalization mortality were analyzed using logistic regression multivariate analysis.
Results: A total of 103,635 patients were studied (mean age 57.3±15.3 years, 61.4% female). There were 14,787 (14.3%) umbilical, 63,685 (61.5%) incisional, and 25,163 (24.3%) other ventral hernias. 215 (0.2%) patients had gangrenous hernia contents. Operative procedures included 59,993 (57.9%) elective and 43,642 (42.1%) emergent VHR. 21.3% elective VHR were laparoscopic versus 13% in emergent cases (P<0.001). Mesh was used in 52,642 (87.7%) elective VHR versus 27,734 (63.5%) emergent VHR (P<0.001). Mortality was 0.2% (n=135) in the elective and 0.6% (n=269) in emergent surgery group (P<0.001). In the elective surgery group, mortality rates were equal among laparoscopic and open VHR (0.2%), while in the emergent surgery group, laparoscopic VHR had a lower mortality rate (0.4% vs 0.6%, P=0.028). In the entire cohort, the median (interquartile range) of length of stay was 2 (3) days in the laparoscopic group and 3 (3) days in the open group (P<0.001), with no significant difference in total hospital charges. Multivariate analysis of elective VHR showed that the following factors were associated with mortality during hospitalization: male gender (Odds Ratio(OR)=2.37), age>50 years (OR=1.96), congestive heart failure (OR=2.15), pulmonary circulation disorders (OR=5.26), coagulopathy (OR=3.93), liver disease (OR=1.89), fluid and electrolyte disturbances (OR=8.66), metastatic cancer (OR=4.66), neurological disorders (OR=2.31), and paralysis (OR=5.29) (Table).
Conclusion: VHR has a low mortality rate, especially when performed laparoscopically. When planning for elective VHR, higher mortality is to be expected in older patients with comorbidities, especially patients with congestive heart failure, pulmonary circulation disorders, coagulopathy, chronic liver disease, metastatic cancer, neurological disorders, and paralysis. Conservative management should be more considered for these high-risk subgroups.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87602
Program Number: S013
Presentation Session: Outcomes/Quality Session
Presentation Type: Podium