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Surgical Endoscopy

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01-11-2010

Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis

Authors: Ashwin Kurian, Sidhbh Gallagher, Abhiman Cheeyandira, Robert Josloff

Published in: Surgical Endoscopy | Issue 11/2010

Abstract

Aim

To identify variables that predict in-hospital length of stay (LOS) after laparoscopic ventral hernia repair (LVHR).

Methods

Univariate analysis of patient and intraoperative variables was conducted on an operating room database of LVHRs performed from April 2001 to April 2009. Analysis was performed using either chi-square or linear trend analysis, as appropriate. A multivariate logistic regression model was created manually, to determine independent variables that predict LOS. p Value <0.05 was considered significant.

Results

A total of 221 patients, with mean age of 56 years (range 25–88 years) underwent LVHR, for a total of 121 incisional and 100 primary ventral hernias. Of patients, 40% had incarcerated hernias and 25% had complex hernias (defined as multiple points of weakness on the anterior abdominal wall). The overall conversion rate to open operation was 6%. Mean LOS was 1.54 days (range 0–22 days). Eighty-six patients (39%) were discharged on the day of the procedure. Variables associated with significantly longer LOS on univariate analysis were incisional hernia (p = 0.000009), mesh size (p = 0.00007), complex hernia (p = 0.00009), incarcerated hernia (p = 0.0004), patient age (p = 0.0006), need for lysis of adhesions (p = 0.001), and female gender (p = 0.01). American Society of Anesthesiologists (ASA) grade >2, conversion to open procedure, and recurrent hernia were not associated with longer LOS. Four factors were independently associated with significant longer length of stay on multivariate logistic regression analysis (p < 0.05): mesh size (p = 0.00005), incarcerated hernia (p = 0.002), patient age (p = 0.018), and complex hernia (p = 0.035).

Conclusions

Mesh size, incarcerated hernia, patient age, and complex hernia predict longer length of stay after laparoscopic ventral hernia repair.

Lomanto S, Iyer G, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035CrossRefPubMed

Mudge M, Hughes LE (1985) Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 72:70–71CrossRefPubMed

Lewis RT, Wiegand FM (1989) Natural history of vertical abdominal parietal closure: prolene versus dexon. Can J Surg 32:196–200PubMed

Hoer J, Lawong G, Klinge (2002) Factors influencing the development of incisional hernia: a retrospective study of 2983 laparotomy patients over a period of 10 years. Chrirug 73:474–480CrossRef

National Center for Health Statistics (2007) Combined surgery data (NHDS and NSAS) data highlights. Available at http://www.hesonline.nhs.uk

Sajid M, Bokhar S, Mallick A, Cheek E, Baig MK (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72CrossRefPubMed

Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83(5):1045–1051CrossRefPubMed

LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41PubMed

Ramshaw BJ, Estaria P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831PubMed

10.

Holzman MD, Purut CM, Reintgen K, Pappa TN (1997) Laparoscopic ventral and incisional hernioplasty. Surg Endosc 11:32–35CrossRefPubMed

11.

Ballem N, Parikh R, Berber E, Siperstein A (2008) Laparoscopic versus open ventral hernia repairs: 5 year recurrence rates. Surg Endosc 22:1935–1940CrossRefPubMed

12.

Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized control trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858CrossRefPubMed

13.

Perrone JM, Soper NJ, Eagon JC, Klingensmith ME, Aft RL, Frisella MM, Brunt LM (2005) Perioperative outcomes and complications of laparoscopic and ventral hernia repair. Surgery 138(4):708–715CrossRefPubMed

14.

Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554CrossRefPubMed

15.

Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie 111:215–225PubMed

16.

Wantz GE (1991) Incisional hernioplasty with mersilene. Surg Gynecol Obstet 172:129–137PubMed

17.

Koehler RH, Voeller G (1999) Recurrences in laparoscopic incisional hernia repairs. A personal series and review of the literature. J Soc Laparoendosc Surg 133:378–382

18.

Luijendijk RW, Hop WC, Van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruininckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398CrossRefPubMed

19.

White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280PubMed

20.

Raftopoulos I, Vanuno D, Khorsand J, Ninos J, Kouraklis G, Lasky P (2002) Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. J Laparoendosc Adv Surg Tech 12(6):425–429CrossRef

21.

Shah RH, Sharma A, Khullar R, Soni V, Baijal M, Chowbey PK (2009) Laparoscopic repair of incarcerated ventral abdominal wall hernias. Hernia 12(5):457–463CrossRef

22.

Saber A, Elgamal M, Mancl T, Norman E, Boros M (2008) Advanced age: Is it an indication or contraindication for laparoscopic ventral hernia repair? JSLS 12:46–50PubMed

23.

Tessier DJ, Swain JM, Harold KL (2006) Safety of laparoscopic ventral hernia repair in older adults. Hernia 10:53–57CrossRefPubMed

24.

Townsend (2007) Sabiston textbook of surgery. Chapter 44: Ventral hernias, 18th edn. W.B. Saunders, Philadelphia

25.

Read RC, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124:485–488PubMed

26.

Bendavid R (2001) Abdominal wall hernias: principles and management. Chapter 88: Epidemiology of hernias in the female. Springer, New York, p 617

Title: Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis
Authors: Ashwin Kurian
Sidhbh Gallagher
Abhiman Cheeyandira
Robert Josloff
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1048-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis

Abstract

Aim

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Methods

Results

Conclusions

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