title: Umbilical herniorrhapy in cirrhosis: improved outcomes with elective repair.
abstract: OBJECTIVE
  This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes.
  
  
  METHODS
  Procedures were identified from the Veterans' Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical records and operative reports were physician abstracted to obtain preoperative and intraoperative variables.
  
  
  RESULTS
  Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%, p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant predictors of complications were emergent case (OR 5.4; 95% CI 3.1-9.4), diabetes (OR 2.1; 95% CI 1.2-3.8), congestive heart failure (OR 4.0; 95% CI 1.4-11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1-3.6). Among emergent repairs, cirrhosis (OR 4.4; 95% CI 1.3-14.3) was strongly associated with postoperative complications.
  
  
  CONCLUSIONS
  Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis.
authors.affiliation: Deep South Center for Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gray
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Vick
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Finan
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Neumayer
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D017558:Elective Surgical Procedures; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome