TY - JOUR
T1 - The Risk of Incarceration During Nonoperative Management of Incisional Hernias
T2 - A Population-based Analysis of 30,998 Patients
AU - Dadashzadeh, Esmaeel R.
AU - Huckaby, Lauren V.
AU - Handzel, Robert
AU - Hossain, M. Shanaz
AU - Sanin, Gloria D.
AU - Anto, Vincent P.
AU - Bou-Samra, Patrick
AU - Moses, J. B.
AU - Cai, Stephen
AU - Phelos, Heather M.
AU - Simmons, Richard L.
AU - Rosengart, Matthew R.
AU - Van Der Windt, Dirk J.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Objective:The aim of the study was to quantify the risk of incarceration of incisional hernias.Background:Operative repair is the definitive treatment for incisional ventral hernias but is often deferred if the perceived risk of elective operation is elevated secondary to comorbid conditions. The risk of incarceration during nonoperative management (NOM) factors into shared decision making by patient and surgeon; however, the incidence of acute incarceration remains largely unknown.Methods:A retrospective analysis of adult patients with an International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis of incisional hernia was conducted from 2010 to 2017 in 15 hospitals of a single healthcare system. The primary outcome was incarceration necessitating emergent operation. The secondary outcome was 30-, 90-, and 365-day mortality. Univariate and multivariate analyses were used to determine independent predictors of incarceration.Results:Among 30,998 patients with an incisional hernia (mean age 58.1 ± 15.9 years; 52.7% female), 23,022 (78.1%) underwent NOM of whom 540 (2.3%) experienced incarceration, yielding a 1- A nd 5-year cumulative incidence of 1.24% and 2.59%, respectively. Independent variables associated with incarceration included: Age older than 40 years, female sex, current smoker, body mass index 30 or greater, and a hernia-related inpatient admission. All-cause mortality rates at 30, 90, and 365 days were significantly higher in the incarceration group at 7.2%, 10%, and 14% versus 1.1%, 2.3%, and 5.3% in patients undergoing successful NOM, respectively.Conclusions:Incarceration is an uncommon complication of NOM but is associated with a significant risk of death. Tailored decision making for elective repair and considering the aforementioned risk factors for incarceration provides an initial step toward mitigating the excess morbidity and mortality of an incarceration event.
AB - Objective:The aim of the study was to quantify the risk of incarceration of incisional hernias.Background:Operative repair is the definitive treatment for incisional ventral hernias but is often deferred if the perceived risk of elective operation is elevated secondary to comorbid conditions. The risk of incarceration during nonoperative management (NOM) factors into shared decision making by patient and surgeon; however, the incidence of acute incarceration remains largely unknown.Methods:A retrospective analysis of adult patients with an International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis of incisional hernia was conducted from 2010 to 2017 in 15 hospitals of a single healthcare system. The primary outcome was incarceration necessitating emergent operation. The secondary outcome was 30-, 90-, and 365-day mortality. Univariate and multivariate analyses were used to determine independent predictors of incarceration.Results:Among 30,998 patients with an incisional hernia (mean age 58.1 ± 15.9 years; 52.7% female), 23,022 (78.1%) underwent NOM of whom 540 (2.3%) experienced incarceration, yielding a 1- A nd 5-year cumulative incidence of 1.24% and 2.59%, respectively. Independent variables associated with incarceration included: Age older than 40 years, female sex, current smoker, body mass index 30 or greater, and a hernia-related inpatient admission. All-cause mortality rates at 30, 90, and 365 days were significantly higher in the incarceration group at 7.2%, 10%, and 14% versus 1.1%, 2.3%, and 5.3% in patients undergoing successful NOM, respectively.Conclusions:Incarceration is an uncommon complication of NOM but is associated with a significant risk of death. Tailored decision making for elective repair and considering the aforementioned risk factors for incarceration provides an initial step toward mitigating the excess morbidity and mortality of an incarceration event.
KW - incisional hernia
KW - nonoperative management
KW - risk of incarceration
UR - http://www.scopus.com/inward/record.url?scp=85123163572&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003916
DO - 10.1097/SLA.0000000000003916
M3 - Article
C2 - 32773624
AN - SCOPUS:85123163572
SN - 0003-4932
VL - 275
SP - E488-E495
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -