复发性腹壁疝手术方式的异质性：质量改进的机会。
Heterogeneity in the surgical approach to recurrent abdominal wall hernias: an opportunity for quality improvement.
机构信息
Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
出版信息
Surg Endosc. 2024 Nov;38(11):6901-6907. doi: 10.1007/s00464-024-11256-1. Epub 2024 Sep 19.
BACKGROUND
Despite being a challenging and morbid clinical problem, operative approaches to recurrent abdominal wall hernia repairs receive little attention. Given this, we performed a retrospective study to evaluate surgical techniques of recurrent abdominal wall hernias requiring reoperation.
METHODS
Adult patients from the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC-COHR) were included in this study. All elective ventral hernia operations performed between January 1, 2020, and March 31, 2023, were included. Descriptive analyses via t-tests and Fisher exact tests were conducted to evaluate sociodemographic, operative, and hernia-specific attributes associated with primary and recurrent hernia repairs.
RESULTS
We identified 8587 patients who underwent elective abdominal wall hernia repair. Of these, 7887 (91.8%) underwent primary repair, and 700 (8.2%) underwent recurrent repair. Patients who underwent recurrent hernia repair were older (mean age 57.9 years vs. 54.1 years, p < 0.001), more often female (53.8% vs. 41.9%, p < 0.001), and had higher BMI (34.0 vs. 32.6, p < 0.001). Patients with recurrent hernias were more likely to have comorbid conditions including hypertension (p < 0.001), diabetes (p < 0.005), COPD (p < 0.01), and BMI > 40 (p < 0.05). Recurrent hernia repairs were more likely to have any 30-day complication (6.4% versus 1.9%, p < 0.001), including higher rates of all surgical site infections. There was no difference in 30-day readmission rates.
CONCLUSION
Considerable variation persists in operative management of recurrent abdominal wall hernias. Importantly, not all recurrent hernias were managed with mesh, which may precipitate additional recurrences and further morbidity. Understanding outcomes for these varied approaches to recurrent hernia repairs is critical to optimize management of this complex clinical problem and prevent future episodes of recurrence.
背景
尽管是一个具有挑战性和病态的临床问题，但对复发性腹壁疝修复的手术方法关注甚少。鉴于此，我们进行了一项回顾性研究，以评估需要再次手术的复发性腹壁疝的手术技术。
方法
本研究纳入密歇根外科质量协作核心优化疝登记处（MSQC-COHR）的成年患者。纳入 2020 年 1 月 1 日至 2023 年 3 月 31 日期间所有择期进行的腹侧疝手术。通过 t 检验和 Fisher 确切检验进行描述性分析，以评估与原发性和复发性疝修复相关的社会人口统计学、手术和疝特异性特征。
结果
我们确定了 8587 例接受择期腹壁疝修复的患者。其中，7887 例（91.8%）接受了原发性修复，700 例（8.2%）接受了复发性修复。接受复发性疝修复的患者年龄更大（平均年龄 57.9 岁 vs. 54.1 岁，p<0.001），更常为女性（53.8% vs. 41.9%，p<0.001），且 BMI 更高（34.0 比 32.6，p<0.001）。复发性疝患者更有可能患有合并症，包括高血压（p<0.001）、糖尿病（p<0.005）、COPD（p<0.01）和 BMI>40（p<0.05）。复发性疝修复更有可能发生任何 30 天并发症（6.4% vs. 1.9%，p<0.001），包括更高的所有手术部位感染发生率。30 天再入院率无差异。
结论
复发性腹壁疝的手术管理方法仍存在很大差异。重要的是，并非所有复发性疝都采用补片治疗，这可能会引发更多的复发和进一步的发病。了解这些复发性疝修复方法的结果对于优化这一复杂临床问题的管理和预防未来复发至关重要。
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