The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA.
Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
Langenbecks Arch Surg. 2023 Jun 26;408(1):246. doi: 10.1007/s00423-023-02984-4.
Umbilical hernia repair (UHR) in cirrhotics with ascites is a challenging problem associated with increased morbidity and mortality. This study examines the outcomes of UHR in veterans, comparing those undergoing elective versus emergent repair.
VASQIP was queried for all UHRs during the period 2008-2015. Data collection included demographics, operative details, Model for End-stage Liver Disease (MELD) score, and postoperative outcomes. Univariate and multivariate regression analyses were performed, and a p value of ≤ 0.05 was considered significant.
A total of 383 patients were included in the analysis. Overall, mean age was 58.9, 99.0% were males, mean body mass index (BMI) was 26.7 kg/m, 98.2% had American Society of Anesthesiologists (ASA) classification ≥ III, and 87.7% had independent functional status. More than 1/3 the patients underwent emergent UHR (37.6%). Compared with the elective UHR group, who underwent emergent repair were older, more likely to be functionally dependent, higher MELD score. Hypoalbuminemia, emergency repair and MELD score were found to be independent predictors of poor outcomes.
UHR in cirrhotic veterans has worse outcomes when performed emergently. Diagnosis should be followed by medical optimization and elective repair, rather than waiting for an emergent indication in > 1/3 of patients.
肝硬化伴腹水患者行脐疝修复（UHR）是一个具有较高发病率和死亡率的难题。本研究通过对比择期与急诊 UHR 手术退伍军人患者的结局，来探讨 UHR 的相关问题。
检索 2008 年至 2015 年期间 VASQIP 中所有 UHR 数据。收集数据包括人口统计学、手术细节、终末期肝病模型（MELD）评分和术后结局。进行单因素和多因素回归分析，p 值≤0.05 认为差异有统计学意义。
共纳入 383 例患者进行分析。总体而言，患者的平均年龄为 58.9 岁，99.0%为男性，平均体重指数（BMI）为 26.7kg/m，98.2%的患者美国麻醉医师协会（ASA）分级≥III 级，87.7%的患者具有独立的功能状态。超过 1/3 的患者行急诊 UHR（37.6%）。与择期 UHR 组相比，急诊 UHR 组患者年龄更大，功能依赖性更高，MELD 评分更高。低白蛋白血症、急诊手术和 MELD 评分是不良结局的独立预测因素。
肝硬化退伍军人行急诊 UHR 的结局更差。对于此类患者，诊断后应进行医疗优化并择期手术，而不是等待有紧急手术指征的患者比例超过 1/3。
