Outcomes of acute versus elective primary ventral hernia repair

Li, Linda T.; Jafrani, Ryan; Becker, Natasha S.; Berger, Rachel L.; Hicks, Stephanie C.; Davila, Jessica A.; Liang, Mike K.

doi:10.1097/ta.0b013e3182ab0743

Cited by 29 publications

(21 citation statements)

References 17 publications

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“…[66][67][68] In addition, it is unlikely that randomized trials could be sufficiently powered to evaluate different treatments of emergency VHR. [66][67][68] In addition, it is unlikely that randomized trials could be sufficiently powered to evaluate different treatments of emergency VHR.…”

Section: Explanation Of Panel Discussionmentioning

confidence: 99%

Ventral Hernia Management

et al. 2017

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Although there was consensus, supported by grade A-C evidence, on patient selection, the safety of short-term nonoperative management, and mesh reinforcement, among experts; there was limited evidence and broad variability in practice patterns in all other areas of practice. The lack of strong evidence and expert consensus on these topics has identified gaps in knowledge where there is need of further evidence.

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Section: Explanation Of Panel Discussionmentioning

confidence: 99%

Ventral Hernia Management

et al. 2017

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“…14 Radiographic imaging has been shown to have significant inter-observer variability. 4 Even patient reported results are inaccurate with up to 1/3 of patients unaware that they have a VIH. 3 Consensus is needed to identify a clinically relevant and standardized method of reporting the presence and absence of a ventral hernia.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 While outcomes of emergency VIH repair are poor, elective repair can be complex and associated with high rates of complications including surgical site infections (SSI: 20-30%) and hernia recurrences (20-30%). 4,5 It is estimated that the United States spends 3.2 billion dollars annually on the surgical management of ventral hernias. Each major complication following the surgical management of a ventral hernia repair costs the healthcare system $30,000 to $210,000 to address.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Risk Stratification Score for Ventral Incisional Hernia after Abdominal Surgery: Hernia Expectation Rates in Intra-Abdominal Surgery (The HERNIA Project)

Goodenough

Kao

et al. 2015

Journal of the American College of Surgeons

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Background Ventral incisional hernias (VIH) develop in up to 20% of patients following abdominal surgery. No widely applicable pre-operative risk-assessment tool exists. We aim to develop and validate a risk-assessment tool to predict VIH following abdominal surgery. Study Design A prospective study of all patients undergoing abdominal surgery was conducted at a single institution from 2008-2010. Variables were defined in accordance with the National Surgical Quality Improvement Project. VIH was determined through clinical and radiographic evaluation. A multivariate Cox proportional hazard model was built from a development cohort (2008-2009) to identify predictors of VIH. The HERNIAscore was created by converting the hazards ratios (HR) to points. The predictive accuracy was assessed on the validation cohort (2010) using a receiver operator characteristic curve and calculating the area under the curve (AUC). Results Of 625 patients followed for a median of 41(0.3-64 months), 93(13.9%) developed a VIH. The training cohort (n=428, VIH=70,16.4%) identified four independent predictors: laparotomy (HR 4.77, 95%CI 2.61-8.70) or hand-assisted laparoscopy (HR=4.00, 95% CI 2.08-7.70), COPD (HR=2.35; 95%CI 1.44-3.83), and BMI≥25 (HR=1.74; 95% CI 1.04-2.91). Factors that were not predictive included age, gender, ASA score, albumin, immunosuppression, prior surgery, and suture material/technique. The predictive score had an AUC=0.77(95%CI0.68-0.86) using the validation cohort (n=197, VIH=23,11.6%). Using the HERNIAscore--HERNIAscore=4*Laparotomy+3*HAL+1*COPD+1* BMI≥25--three classes stratified the risk of VIH: Class I (0-3 points):5.2%, Class II (4-5 points):19.6%, and Class III (6 points):55.0%. Conclusions The HERNIAscore accurately identifies patients at increased risk for VIH. While external validation is needed, this provides a starting point to counsel patients and guide clinical decisions. Increasing the use of laparoscopy, weight-loss programs, community smoking prevention programs, and incisional reinforcement may help reduce rates of VIH.

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“…18,[133][134][135][136][137] Compared to elective repair, repair of ventral hernias in the acute setting is associated with substantially increased morbidity and mortality. (Table 11) Unfortunately, the incidence of emergency surgery for ventral hernias is increasing.…”

Section: Emergent Ventral Hernia Repairmentioning

confidence: 99%