择期腹外疝修补术后死亡率的预测因素：全国住院患者样本分析。

Predictors of mortality after elective ventral hernia repair: an analysis of national inpatient sample.

机构信息

Department of Surgery, College of Medicine, University of Oklahoma, 4502 E 41st Street, Tulsa, OK, 74135, USA.

Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa, OK, USA.

出版信息

Hernia. 2019 Oct;23(5):979-985. doi: 10.1007/s10029-018-1841-x. Epub 2018 Nov 3.

DOI:10.1007/s10029-018-1841-x

PMID:30392164

Abstract

PURPOSE

Deciding between surgery and non-operative management of a non-obstructive ventral hernia (VH) in a high-risk patient often poses a clinical challenge. The aim of this study is to evaluate a national series of open and laparoscopic ventral hernia repair (VHR), and to assess predictors of mortality after elective VHR.

METHODS

A retrospective analysis of 2008-2014 data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample was performed. All patients with a primary diagnosis of abdominal wall hernia were included. Inguinal, femoral, or diaphragmatic hernias were excluded. Patients were stratified by elective versus emergent repair. Factors associated with mortality after elective VHR were analyzed.

RESULTS

103,635 patients were studied, including 14,787 (14.3%) umbilical, 63,685 (61.5%) incisional, and 25,163 (24.3%) other ventral hernias. Operative procedures included 59,993 (57.9%) elective and 43,642 (42.1%) emergent VHR. 21.3% elective VHRs were laparoscopic versus 13% in emergent cases (P < 0.001). Mesh was used in 52,642 (87.7%) elective versus 27,734 (63.5%) emergent VHR (P < 0.001). Median (interquartile range) length of stay was 2(3) days in laparoscopic and 3(3) days in open group (P < 0.001). Mortality was 0.2% (n = 135) in elective and 0.6% (n = 269) in emergent group (P < 0.001). In elective group, mortality rates were equal among laparoscopic and open VHR (0.2%), while in emergent group, it was lower in laparoscopic VHR (0.4% vs 0.6%, P = 0.028). Multivariate analysis of elective VHR showed that the following factors were associated with mortality during hospitalization: age > 50 years [Odds ratio (OR) = 1.96], male gender (OR = 2.37), congestive heart failure (OR = 2.15), pulmonary circulation disorders (OR = 5.26), coagulopathy (OR = 3.93), liver disease (OR = 1.89), fluid and electrolyte disturbances (OR = 8.66), metastatic cancer (OR = 4.66), neurological disorders (OR = 2.31), and paralysis (OR = 5.29).

CONCLUSIONS

VHR has a low mortality, especially when performed laparoscopically. In patients undergoing elective VHR, higher age and some comorbidities are predictors of mortality. These include congestive heart failure, pulmonary circulation disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders, and paralysis. Conservative management should be considered for these high-risk subgroups in context of the overall clinical presentation.

摘要

目的

在高风险患者中，决定是否对非梗阻性腹侧疝（VH）进行手术或非手术治疗常常具有临床挑战性。本研究旨在评估全国范围内的开放式和腹腔镜腹侧疝修复（VHR），并评估择期 VHR 后死亡率的预测因素。

方法

对 2008 年至 2014 年医疗保健成本和利用项目-全国住院患者样本的回顾性分析。所有患有腹壁疝的原发性诊断患者均包括在内。腹股沟、股疝或膈疝被排除在外。根据择期与紧急修复对患者进行分层。分析了择期 VHR 后死亡的相关因素。

结果

共纳入 103635 例患者，其中包括 14787 例（14.3%）脐疝、63685 例（61.5%）切口疝和 25163 例（24.3%）其他腹侧疝。手术包括 59993 例（57.9%）择期和 43642 例（42.1%）紧急 VHR。21.3%的择期 VHR 为腹腔镜手术，而紧急手术为 13%（P<0.001）。52642 例（87.7%）择期 VHR 中使用了网片，而 27734 例（63.5%）紧急 VHR 中使用了网片（P<0.001）。腹腔镜组和开放组的中位（四分位距）住院时间分别为 2（3）天和 3（3）天（P<0.001）。择期组死亡率为 0.2%（n=135），紧急组为 0.6%（n=269）（P<0.001）。在择期组，腹腔镜和开放 VHR 的死亡率相等（0.2%），而在紧急组，腹腔镜 VHR 的死亡率较低（0.4%比 0.6%，P=0.028）。择期 VHR 的多变量分析显示，以下因素与住院期间的死亡率相关：年龄>50 岁[比值比（OR）=1.96]、男性（OR=2.37）、充血性心力衰竭（OR=2.15）、肺循环障碍（OR=5.26）、凝血障碍（OR=3.93）、肝病（OR=1.89）、体液和电解质紊乱（OR=8.66）、转移性癌症（OR=4.66）、神经系统疾病（OR=2.31）和瘫痪（OR=5.29）。