Outcomes of acute versus elective primary ventral hernia repair.
BACKGROUND
The morbidity and mortality associated with acute primary ventral hernia repair have not been well described. We examined the rate of surgical site infection (SSI), hernia recurrence, and mortality in acute versus elective primary ventral hernia repair and identified predictors of morbidity and mortality after primary ventral hernia repair.


METHODS
A retrospective study on all patients undergoing open primary ventral hernia repair at a single institution (2000-2010) was performed. Primary outcomes were mortality at any time, SSI, and recurrence. Survival analysis for the entire, unmatched sample was conducted. We performed a risk-adjusted analysis of outcomes using two methods as follows: (1) case matching and (2) propensity score-adjusted regression model.


RESULTS
We identified 497 patients; 57 (11%) underwent acute primary ventral hernia repair. For the entire cohort, survival was worse for patients undergoing acute repair (log rank, 0.03). Following case matching on age, body mass index, American Society of Anesthesiologists score, and hernia size, there was no difference in mortality, SSI, or recurrence. After propensity score adjustment, acute surgery was not a predictor for mortality or SSI; however, incarcerated hernias predicted recurrence.


CONCLUSIONS
After risk adjustment, acute primary ventral hernia repair was not associated with higher mortality, infection, or recurrence compared with elective repair.


METHODS
Therapeutic study, level IV.
From the Michael E. DeBakey Department of Surgery (L.T.L., R.J.J., N.S.B., M.K.L.), Baylor College of Medicine; Operative Care Line (R.L.B., M.K.L.), Michael E. DeBakey Veterans Affairs Medical Center; Department of Statistics (S.C.H.), Rice University; and Houston Veterans Affairs Health Services Research and Development Center of Excellence (J.A.D.), Houston, Texas.
Linda T
LT
Li
Ryan J
RJ
Jafrani
Natasha S
NS
Becker
Rachel L
RL
Berger
Stephanie C
SC
Hicks
Jessica A
JA
Davila
Mike K
MK
Liang
D000328:Adult; D000368:Aged; 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*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D020379:Risk Adjustment; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome