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Simultaneous Incisional Hernia Repair and Colorectal Surgery: a Case-Matched Study From the ACS-NSQIP
Cigdem Benlice*, Emre Gorgun, Feza H. Remzi
Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
Purpose: Colorectal surgery (CRS) is associated with high incidence of incisional hernia (IH) however simultaneous repair remains is challenging. In this study we evaluated complications and short-term outcomes of patients undergoing simultaneous CRS and IH, and compared the results to case matched group of patients using a large nationwide database.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent simultaneous CRS and IH and were matched 1:2 to patients underwent CRS alone between 2005 and 2010. Patients were identified using primary and secondary Current Procedural Terminology (CPT) codes. Patients with body mass index (BMI) between 18 to 50 kg/m2 and an American Society of Anesthesiologists (ASA) score between I-to IV were included in the analysis. The matching criteria were: type of surgical procedure, diagnosis and ASA score. Short-term (30-day) postoperative morbidity and mortality were compared between the groups.
Results: There were 2075 patients in the simultaneous CRS and IH group, and were matched to 4150 patients with CRS alone. Mean operative time (170 +/-86.8 vs. 148 +/- 76.3 minutes, p<0.001) and length of hospital stay (9 +/-10 vs. 9 +/- 11.2 days, p=0.012) were significantly longer in the simultaneous CRS and IH group. Overall morbidity and mortality rates were similar between the two groups (Table 1). Individual complications were comparable between the groups with an exception of cerebrovascular accident which was higher in simultaneous CRS and IH group (OR 1.839, p=0.016).
Conclusion: Simultaneous incisional hernia repair during colorectal surgery does not increase short term complications in terms of overall morbidity and mortality based on the results from the nationwide database. Prospective studies with long term follow-up are needed to monitor long term effects of simultaneous incisional hernia repair and colorectal surgery.
Table 1. Results of risk adjusted analysis comparing concurrent colorectal surgery and ventral hernia repair and colorectal surgery alone
| Outcome | Univariable OR (95% CI) a | P-value | Multivariable OR (95% CI)b | P-value | | Length of hospital stay. days | 1.053 (1.014 - 1.093) | 0.007 | 1.049 (1.011 - 1.088) | 0.012 | | Operative time, min | 1.152 (1.122 - 1.183) | <0.001 | 1.116 (1.087 - 1.145) | <0.001 | | Superficial SSI | 1.052 (0.875 - 1.265) | 0.59 | 0.985 (0.864 - 1.122) | 0.82 | | Deep SSI | 1.635 (1.109 - 2.411) | 0.013 | 1.290 (0.980 - 1.697) | 0.07 | | Organ space SSI | 1.141 (0.874 - 1.491) | 0.33 | 1.106 (0.915 - 1.336) | 0.3 | | Return to operating room | 1.027 (0.747 - 1.412) | 0.73 | 1.020 (0.883 - 1.180) | 0.78 | | CVA | 2.008 (1.002 - 4.023) | 0.049 | 1.839 (1.119 - 3.022) | 0.016 | | Wound disruption | 1.443 (0.992 - 2.098) | 0.055 | 1.189 (0.912 - 1.550) | 0.2 | | Mortality | 0.802 (0.571 - 1.126) | 0.2 | 0.871 (0.684 - 1.109) | 0.26 | | Morbidity | 1.159 (1.031 - 1.303) | 0.014 | 1.082 (0.995 - 1.176) | 0.07 |
CVA: Cerebrovascular accident; SSI: Surgical site infection; CI: Confidence Interval; a MR = Median Ratio = proportional increase in median LOS or Op Time corresponding to concurrent CRS and VHR relative to CRS alone; derived using Linear Regression of a log2 transformed outcome. OR = Odds Ratio = proportional increase in the odds of the yes/no outcome corresponding to concurrent CRS and VHR relative to CRS alone; derived using logistic regression. b Multivariable analyses adjust for gender, BMI, diabetes mellitus, history of COPD, hypertension as covariates.
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