Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement.
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.
Martínez-Serrano
M Angeles
MA
Department of General and Digestive Surgery, Hospital Universitari del Mar, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
Pereira
José A
JA
Sancho
Juan J
JJ
López-Cano
Manuel
M
Bombuy
Ernest
E
Hidalgo
José
J
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