Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair. Archives of surgery (Chicago, Ill. : 1960) [Arch Surg] Journal article | | Title | Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair. | | Author(s) | Gray SH, Vick CC, Graham LA, Finan KR, Neumayer LA, Hawn MT | | Institution | University of Alabama at Birmingham, 1530 3rd Ave S, KB 429, Birmingham, AL 35294, USA. | | Source | Arch Surg 2008 Jun; 143(6):582-6. | | MeSH | Female
Follow-Up Studies
Hernia, Abdominal
Humans
Incidence
Intestines
Length of Stay
Male
Middle Aged
Postoperative Complications
Prosthesis Implantation
Retrospective Studies
Risk Factors
Surgical Mesh
Surgical Procedures, Elective
Time Factors
Veterans
| | Abstract | HYPOTHESIS: Enterotomy or unplanned bowel resection (EBR) may occur during elective incisional hernia repair (IHR) and significantly affects surgical outcomes and hospital resource use.
DESIGN: Retrospective review of patients undergoing IHR between January 1998 and December 2002.
SETTING: Sixteen tertiary care Veterans Affairs medical centers.
PATIENTS: A total of 1124 elective incisional hernia repairs identified in the National Surgical Quality Improvement Program data set.
INTERVENTION: Elective IHR.
MAIN OUTCOME MEASURES: Thirty-day postoperative complication rate, return to operating room, length of stay, and operative time.
RESULTS: Of the 1124 elective procedures, 74.1% were primary IHR, 13.3% were recurrent prior mesh IHR, and 12.6% were recurrent prior suture. Overall, 7.3% had an EBR. The incidence of EBR was increased in patients with prior repair: 5.3% for primary repair, 5.7% for recurrent prior suture, and 20.3% for prior mesh repair (P < .001). The occurrence of EBR was associated with increased postoperative complications (31.7% vs 9.5%; P < .001), rate of reoperation within 30 days (14.6% vs 3.6%; P < .001), and development of enterocutaneous fistula (7.3% vs 0.7%; P < .001). After adjusting for procedure type, age, and American Society of Anesthesiologists class, EBR was associated with an increase in median operative time (1.7 to 3.5 hours; P < .001) and mean length of stay (4.0 to 6.0 days; P < .001).
CONCLUSIONS: Enterotomy or unplanned bowel resection is more likely to complicate recurrent IHR with prior mesh. The occurrence of EBR is associated with increased postoperative complications, return to the operating room, risk of enterocutaneous fistula, length of hospitalization, and operative time. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
| | PubMed ID | 18559752 |
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