title: Delayed repair of obstructing ventral hernias is associated with higher mortality and morbidity.
abstract: BACKGROUND
  Patients presenting with ventral hernia-related obstruction are commonly managed with emergent ventral hernia repair (VHR). Selected patients with resolution of obstruction may be managed in a delayed manner. This study sought to assess the effect of delay on VHR outcomes.
  
  
  METHODS
  The American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2011 was queried using diagnosis codes for ventral hernia with obstruction. Those who underwent repair over 24 hours after admission were classified as delayed repair. Preoperative comorbid conditions, American Society of Anesthesiology (ASA) scores, and 30-day outcomes were evaluated.
  
  
  RESULTS
  We identified 16,881 patients with a mean age of 58 ± 15 years and body mass index of 36 ± 10. Delayed repair occurred in 27.7% of the patients. After controlling for comorbidities and ASA score, delayed VHR was independently associated with mortality (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.41 to 2.48, P < .001), morbidity (OR 1.4, 95% CI 1.24 to 1.50, P < .001), surgical site infection (OR 1.2, 95% CI 1.03 to 1.35, P = .016), and concurrent bowel resection (OR 1.2, 95% CI 1.03 to 1.34, P = .016).
  
  
  CONCLUSIONS
  VHR for obstructed patients is frequently performed over 24 hours after admission. After adjusting for comorbid conditions and ASA score, delayed VHR is independently associated with worse outcomes. Prompt repair after appropriate resuscitation should be the management of choice.
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Sippey
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
authors.forename: William H H
authors.initials: WH
authors.lastname: Chapman
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Manwaring
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pofahl
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA. Electronic address: spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
mesh_terms: D016208:Databases, Factual; D004766:Enterostomy / Q000706:statistics & numerical data; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology
keywords: Delay; Morbidity; Mortality; Obstruction; Ventral hernia repair