Trends in open abdominal surgery in the United States—Observations from 9,950,759 discharges using the 2009–2013 National Inpatient Sample (NIS) datasets

Carney, Martin J.; Weissler, Jason M.; Fox, Justin P.; Tecce, Michael G.; Hsu, Jesse Y.; Fischer, John P.

doi:10.1016/j.amjsurg.2017.01.001

Cited by 36 publications

(22 citation statements)

References 38 publications

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“…Abdominal wall reconstruction (AWR) is a rapidly developing area of subspecialization. Despite the increasing use of laparoscopy and robotics in surgery, the number of patients developing a ventral hernia and undergoing AWR is growing 1 . The incidence of abdominal wall incisional hernia (AWH) after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up 2–4 , and over 50 per cent among those surviving an abdominal catastrophe 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

et al. 2021

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Background The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. Methods The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. Results Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. Conclusion Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.

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Section: Introductionmentioning

confidence: 99%

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

et al. 2021

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“…28 Although minimally invasive procedures are not associated with decreased incidence of IH, this disparity in treatment could partially explain the disparity in extended duration of stay among Black individuals as open procedures require longer recovery times. 29 Finally, insurance status was strongly associated with both the likelihood of nonelective repair and worse outcomes. Those without insurance have the greatest likelihood of experiencing nonelective admission, followed by Medicaid, Medicare, and "other" payor groups, but only those with government insurance had worse outcomes (Table III).…”

Section: Non-elecɵve Admissionmentioning

confidence: 97%

National health disparities in incisional hernia repair outcomes: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2012-2014

Hoffman

Danos

Lau

2021

Surgery

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Background: Incisional hernias represent an acquired defect from failed healing of an abdominal facial incision and are therefore distinct from primary hernias. While literature regarding incisional hernia incidence, risk factors, and treatment are abundant, no study has examined national health disparities specific to incisional hernia repair. The objective of this study was to analyze national health disparities unique to surgical incisional hernia repair procedures. Methods: Patient data queried from the Healthcare Cost and Utilization Project National Inpatient Sample from 2012 to 2014 using International Classification of Diseases 9th revision procedure codes for incisional hernia repair were used to generate univariate and multivariate models including demographics, socioeconomic factors, admission status, and hospital characteristics. Primary outcomes were nonelective admission status, in-hospital mortality, surgical complications, and extended duration of stay. Results: We estimated that 89,258 incisional hernia repair procedures occurred annually from 2012 to 2014, incurring $6.3 billion in hospital charges. By multivariate analysis, multiple risk factors contribute to significantly increased odds of nonelective repair. These include age over 65, female sex, non-White race, nonprivate insurance, obesity, and increased Charlson comorbidity index. Nonelective incisional hernia repair was strongly correlated with worse outcomes including in-hospital mortality (odds ratio [95% confidence interval] 3.01 [2.51, 3.61]), postoperative complications (odds ratio 1.2 [1.14, 1.25]), and extended duration of stay (odds ratio 2. 96 [2.81, 3.12]). After controlling for admission status, other disparities persisted including extended duration of stay for Black individuals (odds ratio 1.21 (1.12, 1.31]). Conclusion: Providers should be aware of these significant health disparities in incisional hernia repair status and outcomes especially for elderly, non-White, nonprivate insurance, and obese/comorbid patients. Management strategies that increase access to elective repair and that prevent incisional hernia should be expanded to address these disparities.

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“…The human ventral dermis, by contrast, is significantly more exposed and at higher risk of injury. Nearly 2 million abdominal surgeries are performed in the US every year, each involving one or more ventral incisions (Carney et al, 2017). Furthermore, the chest has high skin tension and is among the locations most prone to hypertrophic scars and keloids (Ogawa et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Prrx1 Fibroblasts Represent a Pro-fibrotic Lineage in the Mouse Ventral Dermis

Leavitt

Borrelli

et al. 2020

Cell Reports

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SUMMARY Fibroblast heterogeneity has been shown within the unwounded mouse dorsal dermis, with fibroblast subpopulations being identified according to anatomical location and embryonic lineage. Using lineage tracing, we demonstrate that paired related homeobox 1 (Prrx1)-expressing fibroblasts are responsible for acute and chronic fibroses in the ventral dermis. Single-cell transcriptomics further corroborated the inherent fibrotic characteristics of Prrx1 fibroblasts during wound repair. In summary, we identify and characterize a fibroblast subpopulation in the mouse ventral dermis with intrinsic scar-forming potential.

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Trends in open abdominal surgery in the United States—Observations from 9,950,759 discharges using the 2009–2013 National Inpatient Sample (NIS) datasets

Cited by 36 publications

References 38 publications

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

National health disparities in incisional hernia repair outcomes: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2012-2014

Prrx1 Fibroblasts Represent a Pro-fibrotic Lineage in the Mouse Ventral Dermis

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