Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
J Am Coll Surg. 2012 Dec;215(6):787-93. doi: 10.1016/j.jamcollsurg.2012.08.012. Epub 2012 Sep 19.
The lack of a universally accepted classification system for incisional hernia repair has led to inconsistent reporting of ventral hernia repairs, the inability to compare various series, and the lack of appropriate risk adjusted stratification systems to evaluate surgical outcomes. This study evaluates the Ventral Hernia Working Group's (VHWG) grading scale to accurately predict surgical site occurrence (SSO) after open ventral hernia repair.
All open ventral hernia repairs performed at Case Medical Center were evaluated from a prospectively maintained database. Hernias were graded according to the VHWG grading scale, and patients were evaluated for the incidence of a SSO. The relationships between comorbidities, hernia defect characteristics, CDC wound classification, and SSOs were also evaluated.
There were 299 patients who met inclusion criteria and were available for follow-up. Surgical site occurrence was identified in 14% grade 1, 29% grade 2, 38% grade 3, and 49% grade 4 patients (p = 0.003). However, grade 3 patients with only a previous wound infection had a significantly different incidence of SSO than those with a violation of the gastrointestinal (GI) tract and were actually more similar to grade 2 patients. Likewise, violation of the GI tract had a similar rate of SSO to grade 4 patients. Finally, CDC wound classification also accurately predicted SSO across all levels of contamination.
Modification of the VHWG grading scale into a 3-level grading system would significantly improve the accuracy of predicting SSO after open ventral hernia repair. Grade 2 patients should include those with comorbidities and previous wound infections. Grade 3 patients should be stratified based on CDC definitions of wound contamination. This modified grading scale would significantly improve outcomes reporting after open ventral hernia repair.
由于缺乏普遍接受的切口疝修复分类系统，导致腹疝修复的报告不一致，无法比较各种系列，并且缺乏适当的风险调整分层系统来评估手术结果。本研究评估了腹疝工作组（VHWG）的分级系统，以准确预测开放腹疝修复后的手术部位发生（SSO）。
从一个前瞻性维护的数据库中评估了在 Case Medical Center 进行的所有开放腹疝修复。根据 VHWG 分级系统对疝进行分级，并评估患者 SSO 的发生率。还评估了合并症、疝缺陷特征、CDC 伤口分类与 SSO 之间的关系。
有 299 名符合纳入标准并可进行随访的患者。14%的 1 级、29%的 2 级、38%的 3 级和 49%的 4 级患者发生 SSO（p=0.003）。然而，仅先前存在伤口感染的 3 级患者 SSO 的发生率与胃肠道（GI）道受损的患者有显著差异，实际上与 2 级患者更为相似。同样，GI 道受损的患者 SSO 的发生率与 4 级患者相似。最后，CDC 伤口分类也准确预测了所有污染程度的 SSO。
将 VHWG 分级系统修改为 3 级分级系统，将显著提高预测开放腹疝修复后 SSO 的准确性。2 级患者应包括合并症和先前伤口感染的患者。3 级患者应根据 CDC 对伤口污染的定义进行分层。这种改良的分级系统将显著改善开放腹疝修复后的结果报告。
