Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland.
Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e944-e953. doi: 10.1097/MEG.0000000000002321.
Since there is clinical overlap between populations with cirrhosis and those who require hernia repair (i.e. due to stretching of abdominal walls), we systematically evaluate the effects of cirrhosis on post-hernia repair outcomes.
2011-2017 National Inpatient Sample was used to identify patients who underwent hernia repair (included: inguinal, umbilical, and other abdominal hernia repairs). The population was stratified into those with compensated cirrhosis (CC), decompensated cirrhosis (DC), and no cirrhosis; hepatic decompensation was defined as those with portal hypertension, ascites, and varices. The propensity score was used to match the no-cirrhosis controls to CC and DC using the 1:1 nearest neighbor mechanism. Endpoints included mortality, length of stay, costs, and complications.
Postmatch, there were 392/446 CC/DC with equal number controls in those undergoing inguinal hernia repair, 714/1652 CC/DC with equal number controls in those undergoing umbilical hernia repair, and 784/702 CC/DC. In multivariate, for inguinal repair, there was no difference in mortality [CC vs. no-cirrhosis aOR 2.61, 95% confidence interval (CI) 0.50-13.52; DC vs. no-cirrhosis: aOR 1.75, 95% CI 0.84-3.63]. For umbilical repair, there was no difference in mortality for CC vs. no-cirrhosis: aOR 0.94, 95% CI 0.36-2.42); however, DC had higher mortality (aOR 2.86, 95% CI 1.76-4.63) when comparing DC vs. no-cirrhosis. For other abdominal repairs, there was no difference in mortality for CC vs. no-cirrhosis (aOR 1.10, 95% CI 0.54-2.23); however, DC had higher mortality (P < 0.001, aOR 2.58, 95% CI 1.49-4.46) when comparing DC vs. no-cirrhosis.
This study demonstrates that the presence of DC affects postoperative survival in patients undergoing umbilical or other abdominal hernia repair surgery.
由于肝硬化患者和需要疝修补术（例如由于腹壁拉伸）的患者之间存在临床重叠，因此我们系统地评估了肝硬化对疝修补术后结果的影响。
使用 2011-2017 年全国住院患者样本确定接受疝修补术的患者（包括腹股沟、脐疝和其他腹部疝修补术）。人群分为代偿性肝硬化（CC）、失代偿性肝硬化（DC）和无肝硬化；肝失代偿定义为门静脉高压、腹水和静脉曲张。使用倾向评分通过 1：1 最近邻居机制将无肝硬化对照组与 CC 和 DC 匹配。终点包括死亡率、住院时间、费用和并发症。
在匹配后，接受腹股沟疝修补术的 392/446 CC/DC 与对照组数量相等，接受脐疝修补术的 714/1652 CC/DC 与对照组数量相等，接受其他腹部疝修补术的 784/702 CC/DC 与对照组数量相等。在多变量分析中，对于腹股沟修补术，死亡率没有差异[CC 与无肝硬化的 aOR 为 2.61，95%置信区间（CI）为 0.50-13.52；DC 与无肝硬化的 aOR 为 1.75，95%CI 为 0.84-3.63]。对于脐疝修补术，CC 与无肝硬化的死亡率没有差异：aOR 为 0.94，95%CI 为 0.36-2.42）；然而，与无肝硬化相比，DC 的死亡率更高（aOR 为 2.86，95%CI 为 1.76-4.63）。对于其他腹部修补术，CC 与无肝硬化的死亡率没有差异（aOR 为 1.10，95%CI 为 0.54-2.23）；然而，与无肝硬化相比，DC 的死亡率更高（P <0.001，aOR 为 2.58，95%CI 为 1.49-4.46）。
本研究表明，DC 的存在会影响接受脐疝或其他腹部疝修补术患者的术后生存。
