title: Outcomes of emergent incisional hernia repair.
abstract: This study examines the effect of emergent repair on incisional hernia repair outcomes at 16 Veteran's Affairs Medical Centers between 1998 and 2002. Of the 1452 cases reviewed, 63 (4.3%) were repaired emergently. Patients undergoing emergent repair were older (P = 0.02), more  likely to be black (P = 0.02), and have congestive heart failure (P = 0.001) or chronic obstructive pulmonary disease (P = 0.001). Of emergent repairs, 76.2 per cent involved intestinal incarceration versus 7.2 per cent of elective repairs (P < 0.0001),  and 17.5 per cent had concomitant bowel resection compared with 3.9 per cent of elective cases (P < 0.0001). Patients undergoing emergent repair were also more likely to receive primary suture repair (49.2 vs 31.1%, P = 0.003), develop a postoperative complication (26.0  vs 11.3%, P = 0.002), and have increased postoperative length of stay (7 vs 4 days, P < 0.0001). There were nine (14.3%) deaths at 30 days for the emergent group compared with 10 (0.7%) in the elective group (P < 0.001). However, there was no significant  difference between emergent and elective repairs in long-term complications. Emergent hernia repair is associated with increased mortality rates, early complications, and longer length of stay; however, long-term outcomes are equivalent to elective cases. These data suggest that technical  outcomes for emergent repairs approach those of elective operations.
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama, USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Altom
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gray
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Vick
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004638:Emergency Treatment / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D016896:Treatment Outcome