Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair.
OBJECTIVE
Enterotomy or unplanned bowel resection (EBR) may occur during elective incisional hernia repair (IHR) and significantly affects surgical outcomes and hospital resource use.


METHODS
Retrospective review of patients undergoing IHR between January 1998 and December 2002.


METHODS
Sixteen tertiary care Veterans Affairs medical centers.


METHODS
A total of 1124 elective incisional hernia repairs identified in the National Surgical Quality Improvement Program data set.


METHODS
Elective IHR.


METHODS
Thirty-day postoperative complication rate, return to operating room, length of stay, and operative time.


RESULTS
Of the 1124 elective procedures, 74.1% were primary IHR, 13.3% were recurrent prior mesh IHR, and 12.6% were recurrent prior suture. Overall, 7.3% had an EBR. The incidence of EBR was increased in patients with prior repair: 5.3% for primary repair, 5.7% for recurrent prior suture, and 20.3% for prior mesh repair (P < .001). The occurrence of EBR was associated with increased postoperative complications (31.7% vs 9.5%; P < .001), rate of reoperation within 30 days (14.6% vs 3.6%; P < .001), and development of enterocutaneous fistula (7.3% vs 0.7%; P < .001). After adjusting for procedure type, age, and American Society of Anesthesiologists class, EBR was associated with an increase in median operative time (1.7 to 3.5 hours; P < .001) and mean length of stay (4.0 to 6.0 days; P < .001).


CONCLUSIONS
Enterotomy or unplanned bowel resection is more likely to complicate recurrent IHR with prior mesh. The occurrence of EBR is associated with increased postoperative complications, return to the operating room, risk of enterocutaneous fistula, length of hospitalization, and operative time.
Gray
Stephen H
SH
University of Alabama at Birmingham, 1530 3rd Ave S, KB 429, Birmingham, AL 35294, USA.
Vick
Catherine C
CC
Graham
Laura A
LA
Finan
Kelly R
KR
Neumayer
Leigh A
LA
Hawn
Mary T
MT
D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007422:Intestines / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019919:Prosthesis Implantation / Q000295:instrumentation; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013997:Time Factors; D014728:Veterans