Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances.
OBJECTIVE
Incisional hernias are among the most frequent complications following abdominal surgery with impact on morbidity and mortality rates. Elevated uremia toxins may inhibit granulation tissue formation and impair wound healing, thereby promoting incisional hernia development. Here, we quantified the hazard ratio for incisional hernia prevalence in patients at risk undergoing abdominal reoperations with interrelationship to kidney function. In the same cohort, incidence rates for de novo wound healing disturbances within a4-month follow-up period were determined.


METHODS
Upon hospitalization for elective abdominal surgery in a university hospital (tertiary medical center), past medical histories were recorded in 251 patients and incisional hernia prevalence rates were calculated. Known modifiers for hernia formation as well as laboratory values for estimated glomerular filtration rate (eGFR) were recorded. The status of wound healing was assessed by a blinded investigator 4 months postoperatively. Chronic kidney disease(CKD) was defined as eGFR <60 ml/min/1.73 m2. To identify independent risk factors for incisional hernia or postoperative wound healing disorder, multivariate regression analyses were performed.


RESULTS
The incisional hernia prevalence was 24.3 % in the overall cohort. Patients with CKD (32/251; 12.8 %)were more likely to suffer from incisional hernias with an odds ratio (OR) of 2.8 ([95 % CI 1.2-6.1]; p = 0.014) than patients with eGFR >60 ml/min (219/251; 88.2 %). In multivariate analyses, CKD proved to be an independent risk factor for incisional hernia development with an OR similar to obesity (BMI>25; OR 2.6 [95 % CI 1.3-5.1];p = 0.007). In the prospective analysis, disturbed wound healing occurred in 32 of 251 (12.8 %) patients undergoing abdominal operations. Frequency of wound healing was increased when CKD was present (8/32; 25 %; OR 2.3[95 % CI 1.1–6.7]; p = 0.026) compared to patients with eGFR>60 ml/min (24/219; 11 %).


CONCLUSIONS
Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia development.
Andreas
A
Heller
Saskia E
SE
Westphal
Peter
P
Bartsch
Michael
M
Haase
Peter R
PR
Mertens
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D005919:Glomerular Filtration Rate; D006555:Hernia, Ventral / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D014945:Wound Healing / Q000502:physiology*