From the Michael E. DeBakey Department of Surgery (L.T.L., R.J.J., N.S.B., M.K.L.), Baylor College of Medicine; Operative Care Line (R.L.B., M.K.L.), Michael E. DeBakey Veterans Affairs Medical Center; Department of Statistics (S.C.H.), Rice University; and Houston Veterans Affairs Health Services Research and Development Center of Excellence (J.A.D.), Houston, Texas.
J Trauma Acute Care Surg. 2014 Feb;76(2):523-8. doi: 10.1097/TA.0b013e3182ab0743.
The morbidity and mortality associated with acute primary ventral hernia repair have not been well described. We examined the rate of surgical site infection (SSI), hernia recurrence, and mortality in acute versus elective primary ventral hernia repair and identified predictors of morbidity and mortality after primary ventral hernia repair.
A retrospective study on all patients undergoing open primary ventral hernia repair at a single institution (2000-2010) was performed. Primary outcomes were mortality at any time, SSI, and recurrence. Survival analysis for the entire, unmatched sample was conducted. We performed a risk-adjusted analysis of outcomes using two methods as follows: (1) case matching and (2) propensity score-adjusted regression model.
We identified 497 patients; 57 (11%) underwent acute primary ventral hernia repair. For the entire cohort, survival was worse for patients undergoing acute repair (log rank, 0.03). Following case matching on age, body mass index, American Society of Anesthesiologists score, and hernia size, there was no difference in mortality, SSI, or recurrence. After propensity score adjustment, acute surgery was not a predictor for mortality or SSI; however, incarcerated hernias predicted recurrence.
After risk adjustment, acute primary ventral hernia repair was not associated with higher mortality, infection, or recurrence compared with elective repair.
Therapeutic study, level IV.
急性原发性腹侧疝修复术相关的发病率和死亡率尚未得到很好的描述。我们研究了急性与择期原发性腹侧疝修复术的手术部位感染（SSI）、疝复发和死亡率，并确定了原发性腹侧疝修复术后发病率和死亡率的预测因素。
对一家机构（2000-2010 年）进行的所有开放性原发性腹侧疝修复术患者进行了回顾性研究。主要结局是任何时间的死亡率、SSI 和复发。对整个未匹配样本进行生存分析。我们使用以下两种方法对结果进行风险调整分析：（1）病例匹配和（2）倾向评分调整回归模型。
我们共确定了 497 例患者，其中 57 例（11%）接受了急性原发性腹侧疝修复术。对于整个队列，接受急性修复术的患者生存率更差（对数秩检验，0.03）。在对年龄、体重指数、美国麻醉医师协会评分和疝大小进行病例匹配后，死亡率、SSI 或复发无差异。在倾向评分调整后，急性手术不是死亡率或 SSI 的预测因素；然而，嵌顿疝预测复发。
经过风险调整，与择期修复相比，急性原发性腹侧疝修复术与更高的死亡率、感染或复发无关。
治疗研究，IV 级。
