Umbilical Herniorrhapy in Cirrhosis: Improved Outcomes with Elective Repair |
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Authors: | Stephen H Gray Catherine C Vick Laura A Graham Kelly R Finan Leigh A Neumayer Mary T Hawn |
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Institution: | (1) Deep South Center for Effectiveness Research, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA;(2) Department of Surgery, University of Alabama at Birmingham, KB 429, 1530 3rd Ave. S, Birmingham, AL 35294, USA;(3) Health Services and Outcomes Research Training Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;(4) VA Medical Center and Department of Surgery, University of Utah, Salt Lake City, UT, USA |
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Abstract: | Objective This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes.
Methods Procedures were identified from the Veterans’ Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical
records and operative reports were physician abstracted to obtain preoperative and intraoperative variables.
Results Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%,
p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant
predictors of complications were emergent case (OR 5.4; 95% CI 3.1–9.4), diabetes (OR 2.1; 95% CI 1.2–3.8), congestive heart
failure (OR 4.0; 95% CI 1.4–11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1–3.6). Among emergent repairs,
cirrhosis (OR 4.4; 95% CI 1.3–14.3) was strongly associated with postoperative complications.
Conclusion Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics
is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis. |
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Keywords: | Umbilical hernia Outcomes Cirrhosis Case status |
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