title: Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement.
abstract: OBJECTIVE
  The precise importance of factors affecting morbidity and mortality in patients with complicated abdominal wall hernias undergoing emergency surgical repair has been not completely elucidated.
  
  
  METHODS
  A retrospective multicentric study of all patients (n = 402) with abdominal wall hernia who underwent urgent operations over 1-year period was conducted in ten hospitals. Logistic regression analysis was used to evaluate variables that affect morbidity and mortality.
  
  
  RESULTS
  Thirty-five percent of patients had inguinal hernia, 22% femoral hernia, 20% umbilical hernia, and 15% incisional hernia. Mesh repair was used in 92.5% of cases. Intestinal resection was required in 49 patients. Perioperative complications occurred in 130 patients, and 18 patients died (mortality rate 4.5%). Complications and mortality rate were significantly higher in the group of intestinal resection. Patients older than 70 years also showed more complications, required intestinal resection more frequently, and had a higher mortality rate than younger patients. In the logistic regression analysis, age over 70 years, intestinal resection, and American Society of Anesthesiologists (ASA) III/IV class emerged as independent predictors of a poor outcome. Based in our results, we propose a simple schema to calculate risk of death in these patients.
  
  
  CONCLUSIONS
  Using multivariate logistic regression analysis, probabilities of death after complicated abdominal wall hernia surgery are increased in patients with: age over 70 years, high ASA class, and associated intestinal resection. Guidelines should be developed to improve prognosis in these patients.
authors.affiliation: Department of General and Digestive Surgery, Hospital Universitari del Mar, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Martínez-Serrano
authors.forename: José A
authors.initials: JA
authors.lastname: Pereira
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sancho
authors.forename: Manuel
authors.initials: M
authors.lastname: López-Cano
authors.forename: Ernest
authors.initials: E
authors.lastname: Bombuy
authors.forename: José
authors.initials: J
authors.lastname: Hidalgo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D046449:Hernia, Abdominal / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric