Emergency hernia surgery at a high-volume tertiary centre: a 3-year experience.

BACKGROUND

Hernia surgery is often considered minor. However, emergency abdominal wall hernia (AWH) surgery is associated with significant morbidity. This study reviews a high-volume centre's experience.

METHODS

This is a retrospective review of all emergency AWH operations performed between 2014 and 2017. The following were analysed: patient demographics, ASA grade, type of hernia, time from admission to surgery, use of pre-operative imaging, sac content, details of bowel resection, rate of admission to high dependency unit (HDU)/intensive care unit (ICU), length of stay and morbidity/mortality.

RESULTS

A total of 198 cases were included. Median age was 67.4 years (range 19-95). 52.2% of patients were ASA III or above. Median time from admission to surgery was 13 h (range 1-341) and median length of stay was 4 days (range 1-75). The sac contained bowel in 93 cases (47.0%). These patients had longer length of stay (P < 0.01) and were more frequently admitted to HDU/ICU (P < 0.01). Thirty-one patients underwent bowel resection (33.3% of those with bowel involvement and 15.7% of the total). Twenty-seven patients (13.6%) were admitted to HDU/ICU post-operatively. Six patients (3.0%) had an unplanned return to theatre and 66 patients (33.3%) had a post-operative complication. Inpatient mortality was three (1.51%).

CONCLUSIONS

Patients who undergo emergency AWH surgery represent a relatively aged and co-morbid group. This surgery is associated with significant morbidity and consumes considerable hospital resources. Efforts should be made to identify the higher risk subgroup with bowel involvement. Elderly and co-morbid patients should be listed for timely elective surgery wherever suitable.