Flum David R, Horvath Karen, Koepsell Thomas
Robert Wood Johnson Clinical Scholars Program, Seattle, Washington, USA.
Ann Surg. 2003 Jan;237(1):129-35. doi: 10.1097/00000658-200301000-00018.
To determine if certain outcomes of incisional hernia repair have improved in recent eras.
Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias.
This retrospective, population-based cohort study was conducted using a 1987 to 1999 Washington hospital discharge database. Subjects were all Washington state residents assigned ICD9 procedure codes for incisional hernia repair with or without synthetic material (mesh). Main outcome measure was the rate of reoperative incisional hernia repair, length of hospitalization, and hospital charges based on the use of synthetic material and the era of operative repair (before and after 1995).
A total of 10,822 Washington state patients underwent incisional hernia repair (mean age 58.7 +/- 15.6, 64% female). Of patients undergoing incisional hernia repair, 12.3% underwent at least one subsequent reoperative incisional hernia repair within the first 5 years after initial repair (23.1% at 13 years follow-up). The 5-year reoperative rate was 23.8% after the first reoperation, 35.3% after the second, and 38.7% after the third. The use of synthetic mesh in incisional hernia repairs increased from 34.2% in 1987 to 65.5% in 1999. When controlling for age, sex, comorbidity index of the patient, year of the initial procedure, and hospital descriptors (rural location, nonprofit and teaching status), the hazard for recurrence was 24.1% higher if no mesh was used compared to the hazard if mesh was used. After similar adjustment, no differences were found in the hazard of reoperation based on the era of the operative repair. Mean length of stay for procedures performed after 1995 was 4.9 days compared to 4.8 days in preceding eras.
Incisional hernia repair is associated with high cumulative rates of reoperative repairs. The expectation that important measures of adverse outcome have improved in recent eras is not supported by the results of this large population-based study.
确定在最近的时代里切口疝修补术的某些结果是否有所改善。
据报道，技术发展改善了腹壁切口疝修补术的结果。
这项基于人群的回顾性队列研究使用了1987年至1999年华盛顿医院出院数据库。研究对象为所有华盛顿州居民，他们被分配了ICD9手术编码，用于有或没有使用合成材料（补片）的切口疝修补术。主要结局指标是再次手术切口疝修补率、住院时间和基于合成材料使用情况及手术修复时代（1995年之前和之后）的住院费用。
共有10822名华盛顿州患者接受了切口疝修补术（平均年龄58.7±15.6岁，64%为女性）。在接受切口疝修补术的患者中，12.3%在初次修复后的前5年内至少接受了一次后续再次手术切口疝修补术（随访13年时为23.1%）。首次再次手术后的5年再次手术率为23.8%，第二次为35.3%，第三次为38.7%。切口疝修补术中合成补片的使用从1987年的34.2%增加到1999年的65.5%。在控制患者的年龄、性别、合并症指数、初次手术年份和医院描述指标（农村地区、非营利性和教学状况）后，与使用补片相比，未使用补片时复发风险高24.1%。经过类似调整后，基于手术修复时代的再次手术风险未发现差异。1995年后进行手术的平均住院时间为4.9天，而之前的时代为4.8天。
切口疝修补术与再次手术修复的高累积率相关。这项大型基于人群的研究结果不支持近期不良结局的重要指标有所改善的预期。
