Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality—a single-center experience

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 25; no. 3; pp. 679 - 688
• Main Authors: Surek, A., Gemici, E., Ferahman, S., Karli, M., Bozkurt, M. A., Dural, A. C., Donmez, T., Karabulut, M., Alis, H.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-06-2021; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Abdominal Wall; Aged; Comorbidity; Female; Gender; Hernia; Hernia, Ventral - epidemiology; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Humans; Intestine; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Multivariate analysis; Original Article; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Retrospective Studies; Risk Factors; Statistical analysis; Surgery; Irreducible; Abdominal wall hernias; Mortality; Risk factors; Morbidity
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-020-02293-5

Purpose
Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations.
Methods
The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients’ ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed.
Results
Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (
p
 = 0.009,
p
 < 0.001,
p
 = 0.032, respectively). Advanced age, high ASA scores, CCI and duration of symptom were determined as factors affecting the increase in mortality. In the multivariate analysis, the effect of high ASA scores and advanced age on high mortality rate was statistically significant (
p
 < 0.023,
p
 = 0.039, respectively).
Conclusions
The mortality rate is higher, especially in elderly patients with high comorbidity. Therefore, we argue that the cases of abdominal wall hernia should be operated under elective conditions even if they do not give any clinical findings to prevent problems in older ages.