Department of Surgery, University of Michigan, Ann Arbor.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
JAMA Surg. 2023 Apr 1;158(4):394-402. doi: 10.1001/jamasurg.2022.7978.
Parastomal hernia is a challenging complication following ostomy creation; however, the incidence and long-term outcomes after elective parastomal hernia repair are poorly characterized.
To describe the incidence and long-term outcomes after elective parastomal hernia repair.
DESIGN, SETTING, AND PARTICIPANTS: Using 100% Medicare claims, a retrospective cohort study of adult patients who underwent elective parastomal hernia repair between January 1, 2007, and December 31, 2015, was performed. Logistic regression and Cox proportional hazards models were used to evaluate mortality, complications, readmission, and reoperation after surgery. Analysis took place between February and May 2022.
Parastomal hernia repair without ostomy resiting, parastomal hernia repair with ostomy resiting, and parastomal hernia repair with ostomy reversal.
Mortality, complications, and readmission within 30 days of surgery and reoperation for recurrence (parastomal or incisional hernia repair) up to 5 years after surgery.
A total of 17 625 patients underwent elective parastomal hernia repair (mean [SD] age, 73.3 [9.1] years; 10 059 female individuals [57.1%]). Overall, 7315 patients (41.5%) underwent parastomal hernia repair without ostomy resiting, 2744 (15.6%) underwent parastomal hernia repair with ostomy resiting, and 7566 (42.9%) underwent parastomal hernia repair with ostomy reversal. In the 30 days after surgery, 676 patients (3.8%) died, 7088 (40.2%) had a complication, and 1740 (9.9%) were readmitted. The overall adjusted 5-year cumulative incidence of reoperation was 21.1% and was highest for patients who underwent parastomal hernia repair with ostomy resiting (25.3% [95% CI, 25.2%-25.4%]) compared with patients who underwent parastomal hernia repair with ostomy reversal (18.8% [95% CI, 18.7%-18.8%]). Among patients whose ostomy was not reversed, the hazard of repeat parastomal hernia repair was the same for patients whose ostomy was resited vs those whose ostomy was not resited (adjusted hazard ratio, 0.93 [95% CI, 0.81-1.06]).
In this study, more than 1 in 5 patients underwent another parastomal or incisional hernia repair within 5 years of surgery. Although this was lowest for patients who underwent ostomy reversal at their index operation, ostomy resiting was not superior to local repair. Understanding the long-term outcomes of this common elective operation may help inform decision-making between patients and surgeons regarding appropriate operative approach and timing of surgery.
造口术后发生的肠造口旁疝是一种具有挑战性的并发症；然而，择期肠造口旁疝修补术后的发病率和长期结果描述甚少。
描述择期肠造口旁疝修补术后的发病率和长期结果。
设计、设置和参与者：使用 100%的医疗保险索赔数据，对 2007 年 1 月 1 日至 2015 年 12 月 31 日期间接受择期肠造口旁疝修补术的成年患者进行了回顾性队列研究。使用 logistic 回归和 Cox 比例风险模型评估了术后的死亡率、并发症、再入院和再次手术。分析于 2022 年 2 月至 5 月进行。
无造口重置的肠造口旁疝修补术、有造口重置的肠造口旁疝修补术和有造口反转的肠造口旁疝修补术。
术后 30 天内的死亡率、并发症和再入院率，以及术后 5 年内复发（肠造口或切口疝修补术）的再次手术率。
共有 17625 例患者接受了择期肠造口旁疝修补术（平均[标准差]年龄为 73.3[9.1]岁；10059 例女性[57.1%]）。总体而言，7315 例患者（41.5%）接受了无造口重置的肠造口旁疝修补术，2744 例（15.6%）接受了有造口重置的肠造口旁疝修补术，7566 例（42.9%）接受了有造口反转的肠造口旁疝修补术。术后 30 天内，676 例（3.8%）患者死亡，7088 例（40.2%）患者出现并发症，1740 例（9.9%）患者再入院。总的 5 年累积再手术率为 21.1%，有造口重置的患者最高（25.3%[95%CI，25.2%-25.4%]），其次是有造口反转的患者（18.8%[95%CI，18.7%-18.8%]）。在未行造口反转的患者中，与未行造口重置的患者相比，行造口重置的患者再次发生肠造口旁疝的风险相同（校正后的危险比，0.93[95%CI，0.81-1.06]）。
在这项研究中，超过 1/5 的患者在手术后 5 年内再次接受肠造口旁疝或切口疝修补术。虽然对于在初次手术时行造口反转的患者来说，这一比例最低，但造口重置并不优于局部修复。了解这种常见择期手术的长期结果可能有助于患者和外科医生在适当的手术方法和手术时机方面做出决策。
