Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA.
Ohio State University Wexner Medical Center, 395 W 12th Avenue Suite 670, Columbus, OH, 43210-1267, USA.
Surg Endosc. 2022 Mar;36(3):2159-2168. doi: 10.1007/s00464-021-08458-2. Epub 2021 Mar 31.
The incidence of ventral hernia development after solid organ transplantation has been reported to be up to 30%. We aim to determine the impact of previous solid organ transplant on post-operative length of stay (LOS) and surgical site complications in elective ventral hernia repairs.
A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was conducted to include all patients age 18 years or older who underwent elective incisional hernia repair. Those with and without a history of solid organ transplantation were compared. The primary outcome was in-hospital LOS. Secondary outcomes included 30-day surgical site infection (SSI) rate, 30-day surgical site occurrence requiring procedural intervention (SSOPI) rate, 30-day overall post-operative complications and recurrence. The association between transplant and the LOS was tested with a negative binomial regression model adjusted for the demographic characteristics, comorbidities and hernia characteristics in the model.
The population analyzed included 13,452 (98.79%) patients without a history of organ transplantation and 165 (1.21%) patients who had a history of organ transplantation. After adjusting for age, hernia width, BMI, gender, race, insurance type, ASA class, hypertension, dyspnea, OR time > 2 h, abdominal wall SSI history, recurrent hernia, operative approach the median LOS was not significantly different between patients with a history of solid organ transplant [2.8 (2.6, 2.9) days] and those without [2.6 days (2.2, 3.1)] (p = 0.5). The proportion of SSI (2.4% vs 4.04%; p = 0.42), SSOPI (4.2% vs 5.8%; p = 0.38) and recurrence (0.6% vs 0.4%, p = 0.51) was similar between both groups. Other remaining 30-day post-operative were negligible in our sample.
There were no significant differences in LOS or infection rates between patients with and without a history of solid organ transplantation despite known risks of immunosuppression and chronic steroid use. Therefore, although these patients have many classic risk factors for poor outcomes, the data suggest that their history of solid organ transplantation should not preclude them from surgery.
据报道，实体器官移植后发生腹侧疝的发生率高达 30%。我们旨在确定先前的实体器官移植对择期腹侧疝修复术后住院时间（LOS）和手术部位并发症的影响。
对 Abdominal Core Health Quality Collaborative（ACHQC）前瞻性收集的数据进行回顾性分析，纳入所有年龄在 18 岁或以上接受择期切口疝修复的患者。比较有和无实体器官移植史的患者。主要结局是住院 LOS。次要结局包括 30 天手术部位感染（SSI）率、30 天手术部位需要程序性干预的发生率（SSOPI）、30 天总术后并发症和复发率。使用负二项回归模型测试移植与 LOS 之间的关系，该模型在模型中调整了人口统计学特征、合并症和疝特征。
分析人群包括 13452 名（98.79%）无器官移植史患者和 165 名（1.21%）有器官移植史患者。调整年龄、疝宽度、BMI、性别、种族、保险类型、ASA 分级、高血压、呼吸困难、手术时间＞2 小时、腹壁 SSI 史、复发性疝、手术方式后，实体器官移植史患者的 LOS 中位数无显著差异[2.8（2.6，2.9）天]和无器官移植史患者[2.6 天（2.2，3.1）]（p=0.5）。两组 SSI（2.4% vs 4.04%；p=0.42）、SSOPI（4.2% vs 5.8%；p=0.38）和复发率（0.6% vs 0.4%；p=0.51）的比例相似。我们的样本中其他 30 天术后并发症发生率较低。
尽管存在免疫抑制和长期使用类固醇的已知风险，但有和无实体器官移植史的患者在 LOS 或感染率方面没有显著差异。因此，尽管这些患者有许多导致不良结局的经典危险因素，但数据表明，他们的实体器官移植史不应使他们无法接受手术。
