title: Specific improvement measures to reduce complications and mortality after urgent surgery in complicated abdominal wall hernia.
abstract: OBJECTIVE
  Morbidity and mortality are increased after urgent surgery for complicated abdominal wall hernia. We analysed prospectively early morbidity and mortality after implementing specific management measures in patients undergoing urgent hernia repair.
  
  
  METHODS
  The study population included 244 patients with complicated abdominal wall hernia requiring surgical repair on an emergency basis over 1-year period. Patients were managed according to a protocol that included specific actions to be implemented in the pre-, intra- and postoperative periods. Outcomes of these patients were compared with those of 402 undergoing similar operations before development of the protocol.
  
  
  RESULTS
  Patients in whom acute complication was the first hernia symptom had higher mortality (7.2% vs 2.5%; P = 0.07) and were consulted later than 24 h (49.4% vs 36%; P = 0.044). Patients consulting later than 24 h had higher mortality (8.1% vs 1.4%, P = 0.017). Femoral hernias exhibited specific characteristics and were associated with higher mortality (13% vs 1.6%; P = 0.001). Overall, both groups had similar mortality (4.5% vs 4.1%; P = 0.8); complications (38.8% vs 37.7%; P = 0.2), and bowel resection rates (12.2% vs 11.5%; P = 0.8). Excluding the group of femoral hernias, the measures achieved a lower rate of severe complications (21.2% vs 10.3%; P = 0.04) and a decrease in mortality (2.9% vs 0.6%; P = 0.05) after bowel resection.
  
  
  CONCLUSIONS
  Specific measures for improvement of management and prevention of complications and mortality were effective in patients without femoral hernia. To reduce mortality, the best applicable measure is early detection and to prioritize the scheduled operation of femoral hernias and those affecting high risk patients. The implementation of preventive and educational programs in high risk patients is essential.
authors: Department of General and Digestive Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain. 96048@parcdesalutmar.cat
authors: M A
authors: MA
authors: Martínez-Serrano
authors: J A
authors: JA
authors: Pereira
authors: J
authors: J
authors: Sancho
authors: N
authors: N
authors: Argudo
authors: M
authors: M
authors: López-Cano
authors: L
authors: L
authors: Grande
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D004632:Emergency Medical Services; D005260:Female; D046449:Hernia, Abdominal / Q000401:mortality / Q000601:surgery*; D006550:Hernia, Femoral / Q000401:mortality / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D013526:Surgical Mesh