Gillies Madeline, Anthony Lakmali, Al-Roubaie Aymen, Rockliff Aaron, Phong Jenny
General Surgery, Goulburn Valley Health, Shepparton, AUS.
Vascular Surgery, Northern Hospital Epping, Epping, AUS.
Cureus. 2023 Mar 3;15(3):e35744. doi: 10.7759/cureus.35744. eCollection 2023 Mar.
Background Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for population was 182 per 100,000; this increased by 9.578 per year during the study period (95%CI = 8.431-10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year (95%CI = 0.654-1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95%CI = 0.510-0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.
切口疝和腹疝极为常见，原发性腹疝在约20%的成年人中出现，切口疝在高达30%的腹部中线切口中发生。美国的最新数据显示，择期切口疝和腹疝修补术（IVHR）以及复杂疝的急诊修补术的发病率在上升。本研究调查了澳大利亚在二十年研究期间IVHR的人口趋势。方法：本回顾性研究使用了澳大利亚卫生与福利研究所的手术数据以及澳大利亚统计局2000年至2021年期间收集的人口数据，以计算IVHR手术选定子类按年龄和性别的每10万人发病率。使用简单线性回归评估随时间的趋势。结果：在研究期间，澳大利亚共进行了809,308例IVHR手术。经人口调整后的累积发病率为每10万人182例；在研究期间，这一数字每年增加9.578例（95%置信区间 = 8.431 - 10.726，p <.001）。原发性脐疝的IVHR在经人口调整的发病率方面增长最为显著，每年增加1.177例（95%置信区间 = 0.654 - 1.701，p <.001）。嵌顿、梗阻和绞窄性疝的急诊IVHR每年增加0.576例（95%置信区间 = 0.510 - 0.642，p <.001）。仅20.2%的IVHR手术作为日间手术进行。结论：在过去20年中，澳大利亚的IVHR手术显著增加，尤其是原发性腹疝的手术。因嵌顿、梗阻和绞窄而复杂的疝的IVHR也显著增加。作为日间手术进行的IVHR手术比例远低于澳大利亚皇家外科学院设定的目标。随着IVHR手术发病率的上升以及其中急诊手术比例的增加，在安全的情况下，择期IVHR应作为日间手术进行。
