Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement

被引:30
作者
Angeles Martinez-Serrano, M. [1 ]
Pereira, Jose A. [1 ,2 ]
Sancho, Juan J. [1 ]
Lopez-Cano, Manuel [3 ]
Bombuy, Ernest [4 ]
Hidalgo, Jose [5 ]
机构
[1] Autonomous Univ Barcelona, Dept Gen & Digest Surg, Hosp Univ Mar, Barcelona 08003, Spain
[2] Pompeu Fabra Univ, Dept Hlth & Expt Sci, Barcelona, Spain
[3] Hosp Univ Vall Hebron, Dept Gen Surg, Barcelona, Spain
[4] Consorci Sanitari Maresme, Serv Gen Surg, Mataro, Spain
[5] Hosp Parc Tauli, Serv Gen Surg, Sabadell, Spain
关键词
Abdominal wall hernia repair; Incarcerated hernia; Strangulated hernia; Perioperative complications; Intestinal resection; ASA score; RANDOMIZED CLINICAL-TRIAL; INGUINAL-HERNIA; ELDERLY PATIENTS; GROIN HERNIAS; SURGERY; MANAGEMENT; MORTALITY;
D O I
10.1007/s00423-009-0515-7
中图分类号
R61 [外科手术学];
学科分类号
摘要
The precise importance of factors affecting morbidity and mortality in patients with complicated abdominal wall hernias undergoing emergency surgical repair has been not completely elucidated. A retrospective multicentric study of all patients (n = 402) with abdominal wall hernia who underwent urgent operations over 1-year period was conducted in ten hospitals. Logistic regression analysis was used to evaluate variables that affect morbidity and mortality. Thirty-five percent of patients had inguinal hernia, 22% femoral hernia, 20% umbilical hernia, and 15% incisional hernia. Mesh repair was used in 92.5% of cases. Intestinal resection was required in 49 patients. Perioperative complications occurred in 130 patients, and 18 patients died (mortality rate 4.5%). Complications and mortality rate were significantly higher in the group of intestinal resection. Patients older than 70 years also showed more complications, required intestinal resection more frequently, and had a higher mortality rate than younger patients. In the logistic regression analysis, age over 70 years, intestinal resection, and American Society of Anesthesiologists (ASA) III/IV class emerged as independent predictors of a poor outcome. Based in our results, we propose a simple schema to calculate risk of death in these patients. Using multivariate logistic regression analysis, probabilities of death after complicated abdominal wall hernia surgery are increased in patients with: age over 70 years, high ASA class, and associated intestinal resection. Guidelines should be developed to improve prognosis in these patients.
引用
收藏
页码:551 / 556
页数:6
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