Umbilical Hernia Repair in Patients with Cirrhosis and in Patients with Severe Comorbidities—A Nationwide Cohort Study

Abstract

Introduction Umbilical hernia is a frequent condition in patients with cirrhosis. The aim of the study was to evaluate the risks associated with umbilical hernia repair in patients with cirrhosis in the elective and emergency setting. Secondly, to compare patients with cirrhosis with a population of patients with equally severe comorbidities but without cirrhosis. Methods Patients with cirrhosis who underwent umbilical hernia repair from January 1, 2007, to December 31, 2018, were included from the Danish Hernia Database. A control group of patients with a similar Charlson score (C 3) without cirrhosis was generated using propensity score matching. The primary outcome was postoperative reintervention within 30 days following hernia repair. Secondary outcomes were mortality within 90 days and readmission within 30 days following hernia repair. Results A total of 252 patients with cirrhosis and 504 controls were included. Emergency repair in patients with cirrhosis was associated with a significantly increased rate of re-intervention (54/108 (50%) vs. 24/144 (16.7%), P \ 0.001), 30-day readmission rate (50/108 (46.3%) compared with elective repair vs. 36/144 (25%) (P \ 0.0001)), and 90-day mortality (18/108 (16.7%) vs. 5/144 (3.5%), P \ 0.001). Patients with cirrhosis were more likely to undergo a postoperative re-intervention compared with comorbid patients without cirrhosis (OR = 2.10; 95% ). Conclusion Patients with cirrhosis and other severe comorbidity undergo emergency umbilical hernia repair frequently. Emergency repair is associated with increased risk of poor outcome. Patients with cirrhosis undergo a postoperative reintervention more frequently than patients with other severe comorbidity undergoing umbilical hernia repair.

Hernia Repair in Cirrhotic Patients with Ascites: How Can We Improve?

“…Similar results have already been found by Andraus et al [2]. The novelty of their work, however, was that when comparing acute hernia patients with other operative patients with severe comorbidities, the risk of morbidity and mortality was the same irrespective of cirrhosis [1]. Studies investigating elective umbilical hernia repair in patients with cirrhosis report no increased risk compared to patients without cirrhosis.…”

“…Snitkjaer C et al described the results of umbilical hernia repair in cirrhotic patients based on the Danish hernia database. Their main finding was that emergency hernia repair is associated with higher rates of morbidity and readmission compared with elective repair [1]. Similar results have already been found by Andraus et al [2].…”

“…The most important risk factor therefore is the acute situation. The authors conclude that a shift towards elective repair and preoperative optimization might be beneficial for umbilical hernia patients with cirrhosis [1].…”

“…Patients with comorbidities and cirrhosis might not pass anesthesiologic approval for an elective operation in general anesthesia, however, could be suitable for local anesthesia [4]. The Danish Hernia Database holds no data on the type of anesthesia, so the authors could not give any information on this [1]. Besides the anesthesiologic reason, patients might also be afraid of an elective operation and therefore avoid it, on the other hand, liver patients suffer from cognitive impairment based on hepatic encephalopathy and might not understand the consequences of a necessary operation.…”