Hrebinko Katherine A, Huckaby Lauren V, Silver David, Ratnayake Charith, Hong Yeahwa, Curtis Brett, Handzel Robert M, van der Windt Dirk J, Dadashzadeh Esmaeel Reza
From the Department of Surgery (K.A.H., L.V.H., D.S., Y.H., R.M.H.), University of Pittsburgh Medical Center; Department of Emergency Medicine, University of Pennsylvania, (C.R.,), Philadelphia, PA; Department of Internal Medicine, University of Michigan (B.C.), Ann Arbor, MI; Department of Surgery (D.J.W.), University of Michigan, Ann Arbor, Michigan; and Section of Vascular Surgery, Department of Surgery (E.R.D.), Washington University School of Medicine in St. Louis, St. Louis, Missouri.
J Trauma Acute Care Surg. 2024 Jan 1;96(1):129-136. doi: 10.1097/TA.0000000000003994. Epub 2023 Jun 19.
Acute incisional hernia incarceration is associated with high morbidity and mortality yet there is little evidence to guide which patients will benefit most from prophylactic repair. We explored baseline computed tomography (CT) characteristics associated with incarceration.
A case-control study design was utilized to explore adults (≥18 years) diagnosed with an incisional hernia between 2010 and 2017 at a single institution with a 1-year minimum follow-up. Computed tomography imaging at the time of initial hernia diagnosis was examined. Following propensity score matching for baseline characteristics, multivariable logistic regression was performed to identify independent predictors associated with acute incarceration.
A total of 532 patients (27.26% male, mean 61.55 years) were examined, of whom 238 experienced an acute incarceration. Between two well-matched cohorts with and without incarceration, the presence of small bowel in the hernia sac (odds ratio [OR], 7.50; 95% confidence interval [CI], 3.35-16.38), increasing sac height (OR, 1.34; 95% CI, 1.10-1.64), more acute hernia angle (OR, 0.98 per degree; 95% CI, 0.97-0.99), decreased fascial defect width (OR, 0.68; 95% CI, 0.58-0.81), and greater outer abdominal fat (OR, 1.28; 95% CI, 1.02-1.60) were associated with acute incarceration. Using threshold analysis, a hernia angle of <91 degrees and a sac height of >3.25 cm were associated with increased incarceration risk.
Computed tomography features present at the time of hernia diagnosis provide insight into later acute incarceration risk. Improved understanding of acute incisional hernia incarceration can guide selection for prophylactic repair and thereby may mitigate the excess morbidity associated with incarceration.
Prognostic and Epidemiological; Level III.
急性切口疝嵌顿与高发病率和死亡率相关，但几乎没有证据可指导哪些患者将从预防性修复中获益最大。我们探讨了与嵌顿相关的基线计算机断层扫描（CT）特征。
采用病例对照研究设计，对2010年至2017年在单一机构诊断为切口疝的成年人（≥18岁）进行研究，随访时间至少为1年。检查初次疝诊断时的计算机断层扫描成像。在对基线特征进行倾向评分匹配后，进行多变量逻辑回归以确定与急性嵌顿相关的独立预测因素。
共检查了532例患者（男性占27.26%，平均年龄61.55岁），其中238例发生急性嵌顿。在两组匹配良好的有嵌顿和无嵌顿队列中，疝囊内存在小肠（比值比[OR]，7.50；95%置信区间[CI]，3.35 - 16.38）、疝囊高度增加（OR，1.34；95%CI，1.10 - 1.64）、疝角更锐（每度OR，0.98；95%CI，0.97 - 0.99）、筋膜缺损宽度减小（OR，0.68；95%CI，0.58 - 0.81）以及腹部外侧脂肪增多（OR，1.28；95%CI，1.02 - 1.60）与急性嵌顿相关。通过阈值分析，疝角<91度和疝囊高度>3.25 cm与嵌顿风险增加相关。
疝诊断时的计算机断层扫描特征有助于了解后期急性嵌顿风险。更好地理解急性切口疝嵌顿可指导预防性修复的选择，从而可能减轻与嵌顿相关的额外发病率。
预后和流行病学；三级。
