Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jul;91(7-8):1588-1595. doi: 10.1111/ans.16977. Epub 2021 Jun 14.
This study systematically reviewed the literature regarding perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair, including an audit of the Royal Australasian College of Surgeons (RACS) Australian and New Zealand Audit of Surgical Mortality (ANZASM) database.
A systematic review was conducted in accordance with PRISMA guidelines for the reporting of systematic reviews and meta-analysis of observational studies. Cochrane Library, PubMed, MEDLINE and Embase database searches and data extraction were conducted from June 1979 to October 2019. Statistical analysis was undertaken utilising denominator values for elective hernia procedures derived from the Australian Institute of Health and Welfare (AIHW) data. Risk-adjusted perioperative mortality rates for the relevant procedures were also produced, using a binary logistic regression for the risk adjustment.
Through systematic review of the literature, it was established that the overall reported perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair was low (0.1%-0.5%). Using ANZASM and AIHW data, the calculated risk-adjusted mortality rate for Australian patients was found to be significantly lower (0.04%-0.06%, p < 0.001).
The risk-adjusted mortality rate for elective abdominal wall hernia surgery in Australia is very low and compares favourably to international cohorts. Despite low absolute numbers, the factors which were most significantly associated with increased perioperative mortality in patients undergoing elective surgical abdominal wall hernia repair were increased age, cardiorespiratory co-morbidity and incisional hernia repair.
本研究系统地回顾了人类成人择期手术腹壁疝修补术围手术期死亡率的文献，包括对澳大利亚皇家外科医师学院（RACS）澳大利亚和新西兰手术死亡率审计（ANZASM）数据库的审核。
按照系统评价和观察性研究的 PRISMA 指南进行系统评价。从 1979 年 6 月至 2019 年 10 月，对 Cochrane 图书馆、PubMed、MEDLINE 和 Embase 数据库进行了检索和数据提取。利用澳大利亚卫生与福利研究所（AIHW）数据得出的择期疝手术的分母值进行了统计学分析。还使用二元逻辑回归进行风险调整，得出了相关手术的风险调整围手术期死亡率。
通过对文献的系统回顾，确定人类成人择期手术腹壁疝修补术的总体报告围手术期死亡率较低（0.1%-0.5%）。使用 ANZASM 和 AIHW 数据，发现澳大利亚患者的计算风险调整死亡率明显较低（0.04%-0.06%，p<0.001）。
澳大利亚择期腹壁疝手术的风险调整死亡率非常低，与国际队列相比具有优势。尽管绝对数字较低，但与择期手术腹壁疝修复术患者围手术期死亡率显著相关的因素是年龄较大、心肺合并症和切口疝修复。
