K. Simon1, M. Frelich1, J. Gould1, H. Zhao1, T. Chelius1, M. Goldblatt1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: Ventral hernia (VH) repair remains one of the most common general surgery procedures. The majority of hernia repairs are performed electively. Patients who present emergently with hernia related concerns may experience increased morbidity with repair when compared those repaired electively. Patients who undergo elective surgery may also be different than those who opt to undergo elective surgery. We sought to characterize the outcomes of patients who undergo elective and non-elective VH repair using a large population-based data set.
Methods: The Nationwide Inpatient Sample (NIS) was queried for primary ICD-9 codes associated with VH repair (years 2008-2011). Outcomes were in-hospital mortality and the occurrence of a pre-identified complication. Multivariate analysis was performed to determine the risk factors for complications and mortality following both elective and non-elective VH repair.
Results: We identified 74,151 VH repairs performed during the study interval. Of these procedures, 67.3% were elective and 21.6% were performed laparoscopically. The overall complication rate was 20.0% and overall mortality was 0.95%. Non-elective repair was associated with a significantly higher rate of morbidity (22.5% vs. 18.8%, p<<0.01) and mortality (1.8% vs. 0.52, p<<0.01) than elective repair. Elective repairs were more likely to occur in younger patients, Caucasians, and were more likely to be performed laparoscopically. Logistic modeling revealed that female gender, Caucasian race, elective case status, and laparoscopic approach were independently associated with a lower probability of complications and mortality. Minority status and Medicaid payer status ware associated with increased probability of non-elective admission.
Conclusion: Patients undergoing elective ventral hernia repair in the United States tend to be younger, Caucasian and more likely to have a laparoscopic repair. The need for non-elective VH is associated with a substantial increase in morbidity and mortality. Minority status and Medicaid payer status were associated with increased probability of non-elective admission. Considering the above, we recommend that patients consider elective repair of ventral hernias when possible, to avoid the increased risk of complications associated with non-elective repair.
