Melkemichel Maria, Holmberg Henrik, Dahlstrand Ursula, de la Croix Hanna
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden.
Department of Breast, Endocrine and Sarcoma Tumors, Karolinska University Hospital, 17164 Stockholm, Sweden.
J Clin Med. 2025 Mar 31;14(7):2397. doi: 10.3390/jcm14072397.
: Emergency groin hernia repairs have consistently presented a higher risk of mortality and morbidity. This study aimed to compare both short- and long-term outcomes associated with emergency groin hernia surgery. : A nationwide, population-based cohort study was conducted using prospective collected data from the Swedish Hernia Register combined with a questionnaire assessing patient-reported chronic pain. All patients who underwent a groin hernia repair between 2012 and 2018 were eligible for inclusion. Primary outcomes included 30-day mortality, chronic pain 1-year post-surgery, 30-day postoperative complication, and bowel resection and reoperation for recurrence for emergency versus elective repairs. Risk factors for these outcomes in emergency repair were investigated. : A total of 94,349 repairs were analyzed, with 5401 (5%) emergency repairs. Emergency repairs involved older patients (median age 74 vs. 65), more women (25% vs. 9%), more ASA grade III (38% vs. 12%), more femoral hernias (19% vs. 3%) and smaller defects (24% vs. 17%) compared to elective repairs. Multivariable analysis revealed increased rates and significant risks for 30-day mortality (2.7%, OR 11.61), chronic pain (20.6%, OR 1.30), 30-day postoperative complications (21.9%, OR 2.12) and bowel resection (7.8%, OR 408) compared to elective repairs. No significant difference was observed for reoperation for recurrence. Key risk factors for the outcomes following emergency repairs were higher age, higher ASA grade and femoral hernias. : Emergency hernia surgery continues to pose a high risk of mortality and morbidity. Elective repair should be considered in frail patients and those with potential femoral hernias.
急诊腹股沟疝修补术一直存在较高的死亡率和发病率风险。本研究旨在比较急诊腹股沟疝手术的短期和长期结果。
一项基于全国人群的队列研究使用了从瑞典疝登记处前瞻性收集的数据，并结合一份评估患者报告的慢性疼痛的问卷。2012年至2018年间接受腹股沟疝修补术的所有患者均符合纳入标准。主要结局包括30天死亡率、术后1年慢性疼痛、30天术后并发症以及急诊与择期修补术的肠切除和复发再手术情况。研究了急诊修补术中这些结局的危险因素。
共分析了94349例修补术，其中5401例（5%）为急诊修补术。与择期修补术相比，急诊修补术涉及的患者年龄更大（中位年龄74岁对65岁）、女性更多（25%对9%）、ASAⅢ级更多（38%对12%）、股疝更多（19%对3%）且缺损更小（24%对17%）。多变量分析显示，与择期修补术相比，30天死亡率（2.7%，OR 11.61）、慢性疼痛（20.6%，OR 1.30）、30天术后并发症（21.9%，OR 2.12）和肠切除（7.8%，OR 408）的发生率增加且风险显著。复发再手术未观察到显著差异。急诊修补术后这些结局的关键危险因素是年龄较大、ASA分级较高和股疝。
急诊疝手术仍然具有较高的死亡率和发病率风险。对于体弱患者和有潜在股疝的患者，应考虑择期修补术。
