Department of Surgery, Tufts Medical Center, Boston, MA, USA.
Emergency Surgical Services, Department of Surgery, Tufts Medical Center, Boston, MA, USA.
Updates Surg. 2023 Oct;75(7):1979-1989. doi: 10.1007/s13304-023-01469-9. Epub 2023 Mar 14.
Emergent ventral hernia repair (eVHR) is associated with significant morbidity, yet there is no consensus regarding optimal surgical approach. We hypothesized that eVHR with synthetic mesh would have a higher readmission rate compared to primary eVHR or biologic mesh repair. Retrospective analysis of the Nationwide Readmissions Database (NRD) was conducted for patient entries between 2016 and 2018. Adult patients who underwent eVHR were included. Patient demographics, comorbidities, and surgical techniques were compared between readmitted and non-readmitted patients. Predictors of readmission were assessed using multivariate analysis with propensity weighting for various eVHR techniques. Secondary outcomes included hospital length of stay and readmission diagnoses. 43,819 patients underwent eVHR; of the 22,732 with 6 months of follow-up, 6382 (28.1%) were readmitted. The majority of readmissions occurred within the first 30 days (51.8%). Over half of the readmissions were related to surgical complications (50.6%), the most common being superficial surgical site infection (30.1%) and bowel obstruction/ileus (12.2%). In the multivariate analysis, predictors of 30-day readmission included use of synthetic mesh (OR 1.07, 95% CI 1.00-1.14), biologic mesh (OR 1.26, 95% CI 1.06-1.49), and need for concomitant large bowel resection (OR 1.46, 95% CI 1.30-1.65). eVHR is associated with high rates of readmission. Primary repair had favorable odds for readmission and lower risk of surgical complications compared to synthetic and biologic mesh repairs. Synthetic repair had lower odds of readmission than biologic repair. Given the inherent limitations of the NRD, further institutional prospective studies are required to confirm these findings.
急诊腹外疝修补术（eVHR）与较高的发病率相关，但对于最佳手术方法尚未达成共识。我们假设，与原发性 eVHR 或生物补片修复相比，使用合成补片的 eVHR 再入院率更高。对 2016 年至 2018 年期间的国家再入院数据库（NRD）进行了回顾性分析，纳入接受 eVHR 的成年患者。比较了再入院患者和非再入院患者的患者人口统计学、合并症和手术技术。使用倾向评分对各种 eVHR 技术进行多变量分析，评估再入院的预测因素。次要结局包括住院时间和再入院诊断。共有 43819 例患者接受了 eVHR；在有 6 个月随访的 22732 例患者中，有 6382 例（28.1%）再入院。大多数再入院发生在 30 天内（51.8%）。超过一半的再入院与手术并发症有关（50.6%），最常见的是浅表手术部位感染（30.1%）和肠梗阻/肠麻痹（12.2%）。在多变量分析中，30 天再入院的预测因素包括使用合成补片（OR 1.07，95%CI 1.00-1.14）、生物补片（OR 1.26，95%CI 1.06-1.49）和需要同时进行大肠切除术（OR 1.46，95%CI 1.30-1.65）。eVHR 与高再入院率相关。与合成和生物补片修复相比，原发性修复的再入院和手术并发症风险较低。与生物修复相比，合成修复的再入院风险较低。鉴于 NRD 的固有局限性，需要进一步进行机构前瞻性研究来证实这些发现。
