Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA.
Surg Endosc. 2022 Dec;36(12):9011-9018. doi: 10.1007/s00464-022-09360-1. Epub 2022 Jun 8.
There are a paucity of data regarding the safety of laparoscopic inguinal hernia repair in patients on antiplatelet and anticoagulant therapy (APT/ACT). We aim to compare the postoperative outcomes of laparoscopic (LIHR) vs. open repair of inguinal hernias (OIHR) in patients on APT/ACT.
We conducted a retrospective cohort study using the Vizient Clinical DataBase. We included adults receiving APT/ACT who underwent outpatient, elective, and primary inguinal hernia repair between 2017 and 2019. Subgroup analysis was performed on patients receiving aspirin, non-aspirin antiplatelet, and anticoagulant therapy. Mixed-effects logistic regression was used to assess both the effect of APT/ACT on the probability of receiving LIHR vs OIHR and their respective outcomes.
A total of 142,052 repairs were included, of which 21,441 (15%) were performed on patients receiving APT/ACT. Mean age was 69 years (± 10.5) and 93% were male. 19% of hernias were bilateral. 40% of operations were performed at teaching hospitals. On multivariable analysis, patients on non-aspirin antiplatelet or anticoagulant therapy were more likely to receive an open procedure (Odds Ratio (OR) = 1.2; 95% Confidence Intervals (CI) [1.1, 1.4] and OR = 1.4; CI [1.3, 1.5], respectively). LIHR was associated with a lower rate of length of stay > 1 day (OR = 0.65; CI [0.5, 0.9]). Rates of 30-day postoperative hematoma, transfusions, stroke, myocardial infarction, deep venous thrombosis, pulmonary embolism, readmission, and emergency department visits were similar between the two operative approaches.
Patients on APT/ACT represent a substantial proportion of those undergoing inguinal hernia repair. Non-aspirin antiplatelet or anticoagulant therapy are independent predictors of choosing an open repair. Laparoscopic repair appears to be safe in patients receiving APT/ACT under current perioperative management patterns.
关于正在接受抗血小板和抗凝治疗（APT/ACT）的患者行腹腔镜腹股沟疝修补术的安全性数据较少。我们旨在比较接受 APT/ACT 的患者行腹腔镜（LIHR）与开放式腹股沟疝修补术（OIHR）的术后结果。
我们使用 Vizient 临床数据库进行了回顾性队列研究。我们纳入了 2017 年至 2019 年间接受 APT/ACT 并接受门诊、择期和原发性腹股沟疝修补术的成年人。对接受阿司匹林、非阿司匹林抗血小板和抗凝治疗的患者进行了亚组分析。混合效应逻辑回归用于评估 APT/ACT 对接受 LIHR 与 OIHR 治疗的可能性以及各自结果的影响。
共纳入 142052 例修补术，其中 21441 例（15%）在接受 APT/ACT 的患者中进行。平均年龄为 69 岁（±10.5），93%为男性。19%的疝为双侧疝。40%的手术在教学医院进行。多变量分析显示，接受非阿司匹林抗血小板或抗凝治疗的患者更有可能接受开放手术（优势比（OR）=1.2；95%置信区间（CI）[1.1, 1.4]和 OR=1.4；CI [1.3, 1.5]）。LIHR 与住院时间>1 天的发生率较低相关（OR=0.65；CI [0.5, 0.9]）。两种手术方法的 30 天术后血肿、输血、卒中和心肌梗死、深静脉血栓形成、肺栓塞、再入院和急诊就诊率相似。
正在接受 APT/ACT 的患者代表了接受腹股沟疝修补术的患者的很大一部分。非阿司匹林抗血小板或抗凝治疗是选择开放式修复的独立预测因素。在当前围手术期管理模式下，LIHR 似乎对接受 APT/ACT 的患者是安全的。
