J. Klapholz1,2,3, B. Swett1,2,3, C. Di Maggio1,2,3, S. Castiglioni1,2,3, N. Kennedy1,2,3, L. Krowsoski1,2,3 1NYU Grossman School Of Medicine, General Surgery, New York, NY, USA 2NYU Langone Health, General Surgery, New York, NY, USA 3NYC Health + Hospitals/Bellevue, General Surgery, New York, NY, USA
Introduction:
Surgical repair is the definitive treatment for all hernias, irrespective of location or type. When hernias are diagnosed prior to becoming symptomatic, repair can be conducted electively and with minimal complications. Yet, many hernias progress and lead to incarceration, strangulation, or bowel obstruction that necessitate emergent repair. It is our belief that many of these emergent cases, which often entail prolonged hospital stays and higher morbidity and mortality compared to elective cases, are avoidable with early diagnosis and follow up. To that end, this single-center retrospective cohort study compares the demographics, social factors, and comorbidities of patients who underwent elective hernia repair to those who required emergent surgery. The goal of this study is to identify barriers to diagnosis and treatment of hernias to better facilitate prevention of downstream complications in key populations.
Methods:
Patients > 18 years old who underwent hernia repair at a public hospital in New York City between January 2018 and May 2023 were randomly selected for inclusion in the study. Charts were reviewed in the electronic medical record for demographic descriptors, comorbidities, clinical setting, and hernia type. Univariate and multivariate regression analyses were conducted to compare elective and emergent repair cohorts.
Results:
320 patients were included, 193 (60.0%, 95% CI 55.0, 66.0) in the elective group and 127 (39.7%, 95% CI 34.4, 45.4) in the emergent group. The elective repair group comprised significantly more patients who had been seen in clinic prior to surgery compared to the emergent group (168 (87%) vs. 16 (12.6%) p < 0.001). The emergent group had a significantly higher proportion of males compared to females (p < 0.001). Patients in the emergent group were also significantly older (p < 0.05). There was no association between repair setting and race, Hispanic or Latinx ethnicity, English consent language, or insurance status. With regard to comorbidities, the emergent group had significantly more patients with documented mobility limitations (p < 0.05), prior psychiatric hospitalizations (p < 0.001), and histories of substance abuse (p < 0.001). Diabetes, coronary artery disease, chronic kidney disease, COPD, smoking, cirrhosis, BMI, prior abdominal surgery, and hernia anatomic location showed no associations with elective or emergent repair.
Conclusions:
Patients who were seen in clinic prior to surgery skewed heavily into the elective group. This may reflect that the emergent group had more patients who were either previously lost to follow up or undiagnosed. Other notable aspects of the emergent group were increased age, male sex, mobility limitations, psychiatric history, and substance abuse. These findings provide clarity on vulnerable populations that could benefit from early diagnosis and elective intervention. Further studies are needed to confirm these findings at other centers.