Impact of nonmalignant ascites on outcomes of open inguinal hernia repair in the USA

Hernia - Trang 1-10 - 2023
D. M. Kerekes1, J. A. Sznol1, S. A. Khan1, R. D. Becher1
1Department of Surgery, Yale School of Medicine, New Haven, USA

Tóm tắt

Studies on inguinal hernia repair in patients with ascites are limited, small, and inconsistent, exacerbating a challenging clinical dilemma for surgeons. To fill this gap in the literature, this retrospective cohort study used a national US database to examine the impact of ascites on the outcomes of open inguinal herniorrhaphy. Patients who underwent open inguinal herniorrhaphy between 2005 and 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Two groups were defined by the presence or absence of nonmalignant preoperative ascites. Ascites patients were propensity matched 1:10 with non-ascites patients. Surgical outcomes at 30 days for the matched groups, stratified by electiveness of procedure, were compared, with the primary end points of mortality and the NSQIP composite outcome “serious complication”. The study included 682 patients with ascites. Compared to matched controls, those with ascites had significantly increased odds of mortality (OR 3.3, 95% CI 1.5–7.0) after elective repair, but not after nonelective repair. Ascites was associated with increased odds of serious complication after both elective (OR 1.7, 1.2–2.3) and nonelective (OR 2.0, 1.3–3.0) surgery. Among ascites patients, age ≥ 65 years was associated with increased mortality (risk-adjusted OR 3.8, 1.2–14.4) and serious complication (OR 2.2, 1.2–3.9). In this largest study to date on patients with ascites undergoing open inguinal herniorrhaphy, ascites increased the odds of mortality after elective repair and of serious complication after elective and nonelective repair. Age ≥ 65 was a risk factor for poor outcome. Inguinal herniorrhaphy is fraught with complications in this population.

Tài liệu tham khảo

Rendina M, Viggiani MT, Di Leo A, Barone M (2019) Malnutrition, sarcopenia, and refractory ascites in end stage liver diseases: is there a way to climb back up? Dig Liver Dis 51:1513–1514. https://doi.org/10.1016/j.dld.2019.06.002

Lee DU, Hastie DJ, Lee KJ et al (2021) The impact of compensated and decompensated cirrhosis on the postoperative outcomes of patients undergoing hernia repair: a propensity score-matched analysis of 2011–2017 US hospital database. Euro J Gastroenterol Hepatol 33:944. https://doi.org/10.1097/MEG.0000000000002321

Cho SW, Bhayani N, Newell P et al (2012) Umbilical hernia repair in patients with signs of portal hypertension: surgical outcome and predictors of mortality. Arch Surg 147:864. https://doi.org/10.1001/archsurg.2012.1663

Baron HC (1960) Umbilical hernia secondary to cirrhosis of the liver. Complications of surgical correction. N Engl J Med 263:824–828. https://doi.org/10.1056/NEJM196010272631702

Gray SH, Vick CC, Graham LA et al (2008) Umbilical herniorrhapy in cirrhosis: improved outcomes with elective repair. J Gastrointest Surg 12:675–681. https://doi.org/10.1007/s11605-008-0496-9

Marsman HA, Heisterkamp J, Halm JA et al (2007) Management in patients with liver cirrhosis and an umbilical hernia. Surgery 142:372–375. https://doi.org/10.1016/j.surg.2007.05.006

O’Hara ET, Oliai A, Patek AJ, Nabseth DC (1975) Management of umbilical hernias associated with hepatic cirrhosis and ascites. Ann Surg 181:85–87

Chatzizacharias NA, Bradley JA, Harper S et al (2015) Successful surgical management of ruptured umbilical hernias in cirrhotic patients. World J Gastroenterol 21:3109–3113. https://doi.org/10.3748/wjg.v21.i10.3109

Oh H-K, Kim H, Ryoo S et al (2011) Inguinal hernia repair in patients with cirrhosis is not associated with increased risk of complications and recurrence. World J Surg 35:1229–1233. https://doi.org/10.1007/s00268-011-1007-9

Patti R, Almasio PL, Buscemi S et al (2008) Inguinal hernioplasty improves the quality of life in patients with cirrhosis. Am J Surg 196:373–378. https://doi.org/10.1016/j.amjsurg.2008.02.007

Hur YH, Kim JC, Kim DY et al (2011) Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites. J Korean Surg Soc 80:420–425. https://doi.org/10.4174/jkss.2011.80.6.420

Pinheiro RS, Andraus W, Waisberg DR et al (2019) Abdominal hernias in cirrhotic patients: Surgery or conservative treatment? Results of a prospective cohort study in a high volume center: Cohort study. Ann Med Surg (Lond) 49:9–13. https://doi.org/10.1016/j.amsu.2019.11.009

Abou-Ashour The outcomes of elective versus emergency inguinal hernia repair in cirrhotic patients. https://www.ejs.eg.net/article.asp?issn=1110-1121;year=2016;volume=35;issue=2;spage=140;epage=145;aulast=Abou-Ashour. Accessed 24 Jun 2021

Carbonell AM, Wolfe LG, DeMaria EJ (2005) Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. Hernia 9:353–357. https://doi.org/10.1007/s10029-005-0022-x

Hansen JB, Thulstrup AM, Vilstup H, Sørensen HT (2002) Danish nationwide cohort study of postoperative death in patients with liver cirrhosis undergoing hernia repair. Br J Surg 89:805–806. https://doi.org/10.1046/j.1365-2168.2002.02114.x

ACS NSQIP Participant Use Data File. In: American College of Surgeons. http://www.facs.org/quality-programs/acs-nsqip/participant-use. Accessed 6 Aug 2021

National Cancer Database. In: ACS. https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/. Accessed 17 Feb 2023

Wu JJ, Baldwin BC, Goldwater E, Counihan TC (2017) Should we perform elective inguinal hernia repair in the elderly? Hernia 21:51–57. https://doi.org/10.1007/s10029-016-1517-3

Austin PC (2014) A comparison of 12 algorithms for matching on the propensity score. Stat Med 33:1057–1069. https://doi.org/10.1002/sim.6004

Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107. https://doi.org/10.1002/sim.3697

Rosenbaum PR, Rubin DB (1985) Constructing a Control Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score. Am Stat 39:33–38. https://doi.org/10.2307/2683903

Ecker BL, Bartlett EK, Hoffman RL et al (2014) Hernia repair in the presence of ascites. J Surg Res 190:471–477. https://doi.org/10.1016/j.jss.2014.05.039

stepAIC function - RDocumentation. https://www.rdocumentation.org/packages/MASS/versions/7.3-56/topics/stepAIC. Accessed 6 Apr 2022

Akaike H (1973) Information theory as an extension of the maximum likelihood principle In Petrov BN & Csaki F.(Eds) Second International Symposium on information theory (pp. 267–281)

Portet S (2020) A primer on model selection using the Akaike Information Criterion. Infect Dis Model 5:111–128. https://doi.org/10.1016/j.idm.2019.12.010

Hurst RD, Butler BN, Soybel DI, Wright HK (1992) Management of groin hernias in patients with ascites. Ann Surg 216:696–700. https://doi.org/10.1097/00000658-199212000-00013

(2018) International guidelines for groin hernia management. Hernia. 22:1–165. Doi: https://doi.org/10.1007/s10029-017-1668-x

Aithal GP, Palaniyappan N, China L et al (2021) Guidelines on the management of ascites in cirrhosis. Gut 70:9–29. https://doi.org/10.1136/gutjnl-2020-321790

Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403. https://doi.org/10.1007/s10029-009-0529-7

Biggins SW, Angeli P, Garcia-Tsao G et al (2021) Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the american association for the study of liver diseases. Hepatology 74:1014–1048. https://doi.org/10.1002/hep.31884

Pipek LZ, Cortez VS, Taba JV et al (2022) Cirrhosis and hernia repair in a cohort of 6352 patients in a tertiary hospital: risk assessment and survival analysis. Medicine (Baltimore) 101:31506. https://doi.org/10.1097/MD.0000000000031506

Johnson KM, Newman KL, Berry K et al (2022) Risk factors for adverse outcomes in emergency versus nonemergency open umbilical hernia repair and opportunities for elective repair in a national cohort of patients with cirrhosis. Surgery 172:184–192. https://doi.org/10.1016/j.surg.2021.12.004

Chiejina M, Kudaravalli P, Samant H (2022) Ascites. In: StatPearls. StatPearls Publishing, Treasure Island (FL)

Salamone G, Licari L, Guercio G et al (2018) The abdominal wall hernia in cirrhotic patients: a historical challenge. World J Emerg Surg 13:35. https://doi.org/10.1186/s13017-018-0196-z

Thông tin
Thông tin xuất bản

Hernia

1-10

Thông tin tác giả