Department of General and Digestive Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
Hernia. 2012 Apr;16(2):171-7. doi: 10.1007/s10029-011-0875-0. Epub 2011 Sep 11.
Morbidity and mortality are increased after urgent surgery for complicated abdominal wall hernia. We analysed prospectively early morbidity and mortality after implementing specific management measures in patients undergoing urgent hernia repair.
The study population included 244 patients with complicated abdominal wall hernia requiring surgical repair on an emergency basis over 1-year period. Patients were managed according to a protocol that included specific actions to be implemented in the pre-, intra- and postoperative periods. Outcomes of these patients were compared with those of 402 undergoing similar operations before development of the protocol.
Patients in whom acute complication was the first hernia symptom had higher mortality (7.2% vs 2.5%; P = 0.07) and were consulted later than 24 h (49.4% vs 36%; P = 0.044). Patients consulting later than 24 h had higher mortality (8.1% vs 1.4%, P = 0.017). Femoral hernias exhibited specific characteristics and were associated with higher mortality (13% vs 1.6%; P = 0.001). Overall, both groups had similar mortality (4.5% vs 4.1%; P = 0.8); complications (38.8% vs 37.7%; P = 0.2), and bowel resection rates (12.2% vs 11.5%; P = 0.8). Excluding the group of femoral hernias, the measures achieved a lower rate of severe complications (21.2% vs 10.3%; P = 0.04) and a decrease in mortality (2.9% vs 0.6%; P = 0.05) after bowel resection.
Specific measures for improvement of management and prevention of complications and mortality were effective in patients without femoral hernia. To reduce mortality, the best applicable measure is early detection and to prioritize the scheduled operation of femoral hernias and those affecting high risk patients. The implementation of preventive and educational programs in high risk patients is essential.
复杂腹壁疝患者行紧急手术后发病率和死亡率增加。我们分析了在实施特定管理措施后，行紧急疝修补术患者的早期发病率和死亡率。
本研究纳入了 1 年内 244 例因复杂腹壁疝需紧急手术的患者。根据包括围手术期特定措施的方案对患者进行管理。将这些患者的结果与 402 例在方案制定前接受类似手术的患者进行比较。
以急性并发症为首发疝症状的患者死亡率更高（7.2%比 2.5%；P=0.07），就诊时间晚于 24 小时（49.4%比 36%；P=0.044）。就诊时间晚于 24 小时的患者死亡率更高（8.1%比 1.4%，P=0.017）。股疝具有特定特征，与更高的死亡率相关（13%比 1.6%；P=0.001）。总体而言，两组的死亡率（4.5%比 4.1%；P=0.8）、并发症发生率（38.8%比 37.7%；P=0.2）和肠切除率（12.2%比 11.5%；P=0.8）相似。排除股疝组后，这些措施使严重并发症发生率降低（21.2%比 10.3%；P=0.04），肠切除术后死亡率降低（2.9%比 0.6%；P=0.05）。
对于无股疝的患者，特定的管理改进措施和预防并发症及死亡率的措施是有效的。为降低死亡率，最佳适用措施是早期发现，并优先安排股疝和高危患者的择期手术。在高危患者中实施预防和教育计划至关重要。
