Kokotovic D, Sjølander H, Gögenur I, Helgstrand F
Department of Surgery, Zealand Univeristy Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
Hernia. 2017 Aug;21(4):563-568. doi: 10.1007/s10029-017-1606-y. Epub 2017 Apr 11.
Postoperative surgical complications arising from ventral hernia repair have been assessed by a variety of outcome measures. The objective of this study was to correlate the Clavien Dindo Classification (CDC) graded complications with the 30-day readmission rate as early outcome measures in ventral hernia repair. Secondarily, we wanted to investigate whether the risk factors for Clavien Dindo class ≥1 and 30-day readmission were comparable.
Single-centre retrospective study including all patients (≥18 years) who underwent ventral hernia repair between January 1, 2009 and September 1, 2014 at Zealand University Hospital. Data were obtained from hospital files and the Danish National Patient Registry. A 100% follow-up was obtained.
In total, the study included 700 patients (261 patients with incisional hernia repair and 439 patients with umbilical or epigastric hernia repair). There was a significant association between a complication graded by the CDC ≥1 and 30-day readmission for both incisional and umbilical/epigastric hernia repair (p < 0.001). In incisional hernia, larger hernia size was an independent risk factor for CDC ≥1. No independent risk was found for 30-day readmission. Recurrent (vs. primary) hernia repair was an independent risk factors for both CDC ≥1 and 30-day readmission in umbilical/epigastric hernia repair. Furthermore, hernia size 2-7 cm (vs. >2 cm) was a risk factor for CDC ≥1 but not for 30-day readmission in umbilical/epigastric hernia repair.
Reports on 30-day readmission can be used as a general outcome measure in ventral hernia repair, however CDC provides a more precise and detailed registration of postoperative complications.
通过多种结果指标对腹疝修补术后的手术并发症进行了评估。本研究的目的是将Clavien-Dindo分类（CDC）分级的并发症与30天再入院率相关联，作为腹疝修补术的早期结果指标。其次，我们想研究Clavien-Dindo分级≥1级并发症和30天再入院的危险因素是否具有可比性。
单中心回顾性研究，纳入2009年1月1日至2014年9月1日在西兰岛大学医院接受腹疝修补术的所有患者（≥18岁）。数据来自医院档案和丹麦国家患者登记处。获得了100%的随访数据。
本研究共纳入700例患者（261例行切口疝修补术，439例行脐疝或上腹疝修补术）。对于切口疝修补术和脐疝/上腹疝修补术，CDC分级≥1级的并发症与30天再入院之间均存在显著关联（p<0.001）。在切口疝中，疝块较大是CDC≥1级的独立危险因素。未发现30天再入院的独立危险因素。在脐疝/上腹疝修补术中，复发性（相对于原发性）疝修补术是CDC≥1级和30天再入院的独立危险因素。此外，在脐疝/上腹疝修补术中，疝大小为2-7 cm（相对于>2 cm）是CDC≥1级的危险因素，但不是30天再入院的危险因素。
30天再入院报告可作为腹疝修补术的一般结果指标，然而CDC能更精确、详细地记录术后并发症。
