title: Risk factors for early-occurring and late-occurring incisional hernias after primary laparotomy for ovarian cancer.
abstract: OBJECTIVE
  To evaluate a cohort of gynecologic oncology patients to discover risk factors for early- and late-occurring incisional hernia after midline incision for ovarian cancer.
  
  
  METHODS
  We collected retrospective data from patients undergoing primary laparotomy for ovarian cancer at the University of Wisconsin Hospitals and Clinics from 2001 to 2007. Patient characteristics and potential risk factors for hernia formation were noted. Physical examination, abdominal computerized assisted tomography scans, or both were used to detect hernias 1 year after surgery (early hernia) and 2 years after surgery (late hernia).
  
  
  RESULTS
  There were 265 patients available for the 1-year analysis and 189 patients for the 2-year analysis. Early and late hernia formation occurred in 9.8% (95% confidence interval [CI] 6.2-12%) and an additional 7.9% (95% CI 4.1-12%) of patients, respectively. Using multiple logistic regression, poor nutritional status (albumin less than 3 g/dL) and suboptimal cytoreductive surgery (1 cm or greater residual tumor) were significantly associated with the formation of early incisional hernia after midline incision (P<.001 for both). Late hernia formation was associated only with age 65 years or older (P=.01).
  
  
  CONCLUSIONS
  The formation of early incisional hernias after midline incision is associated with poor nutritional status and suboptimal cytoreductive surgery, whereas late hernia formation is associated with advanced age.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Wisconsin Hospital and Clinics, and the Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and the Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Spencer
authors.forename: Kristin D
authors.initials: KD
authors.lastname: Hayes
authors.forename: Stephen
authors.initials: S
authors.lastname: Rose
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhao
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rathouz
authors.forename: Laurel W
authors.initials: LW
authors.lastname: Rice
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Al-Niaimi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006547:Hernia / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014922:Wisconsin / Q000453:epidemiology; D055815:Young Adult