Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study

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Abstract

Purpose

This study aimed to explore risk factors of postoperative complications for adult patients with incarcerated groin hernia (IGH).

Methods

From January 2010 to December 2017, consecutive patients undergoing emergency hernia repair for IGH in our center were retrospectively reviewed. Postoperative complications, such as surgical site infection, seroma, hernia recurrence and mortality, were investigated, with risk factors for such complications analyzed using univariate and multivariate regressions.

Results

Sixty-four patients were included, with 51 males and 13 females (mean age 65.1, range 25–98 years). Ten patients (15.6%) underwent resection of necrotic bowel and anastomosis. 43 patients (67.2%) received open tension-free herniorrhaphy with polypropylene mesh, whereas the rest (32.8%) received herniorrhaphy without mesh. The overall postoperative complication rate was 40.6% (26/64), with an incisional complication rate of 31.2% (20/64) and an infection rate of 6.2% (4/64). At a median follow-up of 32 months, hernia recurrence and mortality were recorded in five cases each (7.8%). Mesh repair was associated with decreased recurrence rate compared with non-mesh repair (2.3% vs. 19.0%, p = 0.019). Diabetes mellitus (OR 8.611, 95%CI 1.292–57.405; p = 0.026) was an independent risk factor of postoperative complications, together with chronic obstructive pulmonary disease (COPD; OR 14.365, 95%CI 1.652–127.767, p = 0.016), intestinal necrosis (OR 14.260, 95%CI 1.079–188.460, p = 0.044), and general anesthesia (OR 14.543, 95%CI 1.682–125.711, p = 0.015) as risk for incisional complications after surgery.

Conclusions

Diabetes mellitus was an independent risk factor of postoperative complications for IGH, along with COPD, intestinal necrosis and general anesthesia associated with incisional complications. The use of polypropylene mesh did not increase infection or recurrence rate in this cohort.

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Most cited references 30

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Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair.

M Sajid, C Leaver, M K Baig … (2012)

The objective of this study was systematically to analyse published randomized trials comparing lightweight mesh (LWM) with heavyweight mesh (HWM) in open inguinal hernia repair.

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Incarcerated groin hernias in adults: presentation and outcome.

Ricardo F. Baldonedo-Cernuda, G Bear, Luis A J Alvarez … (2004)

Despite universal acceptance of the value of elective hernia repair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality. We reviewed 147 patients who underwent emergency surgery for incarcerated groin hernias during a 10-year period in order to analyze the presentation and outcome in our practice. Median age of the patients was 70 years. There were 77 men and 70 women. Femoral hernias were seen in 77 patients and inguinal hernias in 70. Coexisting diseases were found in 82 cases (55.8%). Bowel resection was required in 19 patients (12.9%). The overall and major morbidity rates were 41.5% and 9.6%, respectively. The mortality rate was 3.4%. Longer duration of symptoms, late hospitalization, concomitant diseases, and high ASA class were found to be significant factors linked with unfavorable outcomes. Because of high morbidity and mortality associated with incarceration, elective repair of groin hernias should be done whenever possible.

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Abdominal wall hernias: risk factors for infection and resource utilization.

Fergal Malone, Maria Napolitano, J. Katthleen Tracy … (2003)

Abdominal wall hernia repairs are common surgical procedures. Several recent reports have studied the outcomes of elderly patients undergoing inguinal hernia repair and documented a morbidity rate ranging from 5-57% and a mortality rate ranging from 1.6-14%. However, there has been limited data documenting the risk factors associated with postoperative morbidity and mortality from abdominal wall hernia repairs in general. Therefore, we sought to investigate the incidence of complications in patients undergoing abdominal wall hernia repair and to evaluate the risk factors for infection and resource utilization in these patients. Prospective data (NSQIP) were collected on 6301 noncardiac surgical patients at the VA Maryland Healthcare System from 1995 to 2000. From this data set, 487 (7.7%) patients underwent abdominal wall hernia repairs and comprised the study cohort. Logistic and linear regression analyses were performed to identify risk factors for infection and hospital length of stay. The mean age of the study cohort was 60 +/- 14 and the mean ASA class was 2.4 +/- 0.7. Descriptive data revealed 99% were male, 43% used tobacco, 8.4% were diabetic, 7.4% used alcohol, 6.3% had chronic obstructive pulmonary disease (COPD), 2.1% were malnourished (defined as >/= 10% weight loss over prior 6 months), 1.6% used steroids, 1.2% had ascites, and 0.2% had coronary artery disease (CAD). The mortality rate was low at 1% but the morbidity rate was higher with a 4.3% incidence of wound infections and a 15.1% incidence of recurrent hernias. The mean preoperative serum albumin level was 4.1 +/- 0.6 g/dL, and the mean hospital length of stay was 1.4 +/- 4.8 days. Multiple logistic and linear regression analyses documented that CAD, COPD, low preoperative serum albumin, and steroid use were independent risk factors for increased postoperative wound infections (P < 0.05) and increased hospital length of stay (P < 0.05). Abdominal wall hernia repair is associated with significant morbidity in this predominantly elderly cohort but mortality rates were low. COPD and low preoperative serum albumin were independent predictors of wound infections and CAD, COPD, low preoperative serum albumin, and steroid use were independent predictors of increased hospital length of stay. Therefore, consideration should be given to optimizing patient's cardiopulmonary and nutritional status before abdominal wall hernia repair.

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Author and article information

Contributors

M. Tan: tantommy@126.com

Y. Yuan:

ORCID: http://orcid.org/0000-0001-5786-4377

condor.yyj@gmail.com

Journal

Journal ID (nlm-ta): Hernia

Journal ID (iso-abbrev): Hernia

Title: Hernia

Publisher: Springer Paris (Paris )

ISSN (Print): 1265-4906

ISSN (Electronic): 1248-9204

Publication date (Electronic): 12 November 2018

Publication date PMC-release: 12 November 2018

Publication date (Print): 2019

Volume: 23

Issue: 2

Pages: 267-276

Affiliations

[1 ]GRID grid.412615.5, Center of Gastrointestinal Surgery, , The First Affiliated Hospital of Sun Yat-sen University, ; Guangzhou, 510080 Guangdong Province People’s Republic of China

[2 ]GRID grid.412615.5, Center of Hernia and Abdominal Wall Surgery, , The First Affiliated Hospital of Sun Yat-sen University, ; Guangzhou, 510080 Guangdong Province People’s Republic of China

Author information

Y. Yuan http://orcid.org/0000-0001-5786-4377

Article

Publisher ID: 1854

DOI: 10.1007/s10029-018-1854-5

PMC ID: 6456471

PubMed ID: 30421299

SO-VID: a55de46e-2ff5-4352-bd73-ff3c4bb70a5c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 28 June 2018

Date accepted : 8 November 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81401307

Award Recipient : Y. Yuan

Funded by: Guangdong Province science and technology planning project

Award ID: 2016A0103038

Award Recipient : W. Dai

Custom metadata

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: incarcerated groin hernia,herniorrhaphy,synthetic mesh,complications,risk factors

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ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: incarcerated groin hernia, herniorrhaphy, synthetic mesh, complications, risk factors

Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study

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Karger: Gastroenterology

Most cited references 30

Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair.

Incarcerated groin hernias in adults: presentation and outcome.

Abdominal wall hernias: risk factors for infection and resource utilization.

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