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01-06-2017 | Original Article

Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database

Authors: P. J. Chung, J. S. Lee, S. Tam, A. Schwartzman, M. O. Bernstein, L. Dresner, A. Alfonso, G. Sugiyama

Published in: Hernia | Issue 3/2017

Abstract

Purpose

Anterior abdominal wall hernias are among the most commonly encountered surgical disease. We sought to identify risk factors that are associated with 30-day postoperative mortality following emergent abdominal wall hernia repair using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Methods

A retrospective analysis of data from the ACS NSQIP from 2005 to 2010 was performed. Patients were selected using Current Procedural Terminology (CPT) and International Classification of Disease 9 Clinical Modification (ICD9) codes for the repair of inguinal, femoral, umbilical, epigastric, ventral, or incisional hernias that were incarcerated, obstructed, strangulated, or gangrenous. Only emergent cases occurring within two days of admission and admitted as inpatients were included. Univariate and multivariable analysis was performed. A risk score was also created.

Results

There were 4298 cases of emergent anterior abdominal wall hernia surgery. The most common was inguinal (25.3 %), followed by incisional (23.8 %), umbilical (23.5 %), ventral (12.1 %), femoral (8.8 %), and epigastric (6.5 %) hernias. Multivariable analysis demonstrated six statistically significant predictors of short-term mortality, including history of congestive heart failure (CHF) [odds ratio (OR) 8.24, 95 % confidence interval (CI) 4.05–16.75), age (OR 5.52, 95 % CI 3.48–8.77), history of peripheral vascular disease (PVD) (OR 4.98, 95 % CI 2.08–11.92), presence of ascites (OR 3.16, 95 % CI 1.64–6.08), preoperative blood urea nitrogen (OR 1.35, 95 % CI 1.22–1.49), and preoperative white blood cell count (OR 1.22, 95 % CI 1.02–1.45). The C-statistic for the risk model was 0.858.

Conclusion

We present a large study on short-term mortality following emergent anterior abdominal wall hernia repairs based on the ACS NSQIP with a derived risk model that demonstrates excellent discriminative ability.

Stroupe KT, Manheim LM, Luo P et al (2006) Tension-free repair versus watchful waiting for men with asymptomatic or minimally symptomatic inguinal hernias: a cost-effectiveness analysis. J Am Coll Surg 203(4):458–468. doi:10.1016/j.jamcollsurg.2006.06.010 CrossRefPubMed

Abi-Haidar Y, Sanchez V, Itani KMF (2011) Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 213(3):363–369. doi:10.1016/j.jamcollsurg.2011.05.008 CrossRefPubMed

Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83(5):1045–1051. doi:10.1016/S0039-6109(03)00132-4 CrossRefPubMed

Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183. doi:10.1007/s10029-011-0879-9 CrossRefPubMed

Colavita PD, Walters AL, Tsirline VB et al (2013) The regionalization of ventral hernia repair: occurrence and outcomes over a decade. Am Surg 79(7):693–701PubMed

Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the United States. JAMA Surg 150(3):194–200. doi:10.1001/jamasurg.2014.1242 CrossRefPubMed

Derici H, Unalp HR, Bozdag AD, Nazli O, Tansug T, Kamer E (2007) Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia 11(4):341–346. doi:10.1007/s10029-007-0226-3 CrossRefPubMed

Altom LK, Snyder CW, Gray SH, Graham LA, Vick CC, Hawn MT (2011) Outcomes of emergent incisional hernia repair. Am Surg 77(8):971–976PubMed

Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F (2001) Emergency hernia repairs in elderly patients. Am J Surg 182(5):455–459. doi:10.1016/S0002-9610(01)00765-6 CrossRefPubMed

10.

Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg 37(10):2273–2279. doi:10.1007/s00268-013-2123-5 CrossRefPubMed

11.

Cohen ME, Ko CY, Bilimoria KY et al (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 217(2):336–346.e1. doi:10.1016/j.jamcollsurg.2013.02.027 CrossRefPubMed

12.

Bilimoria KY, Liu Y, Paruch JL et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217(5):833–842.e1–3. doi:10.1016/j.jamcollsurg.2013.07.385 CrossRefPubMedPubMedCentral

13.

Rowell KS, Turrentine FE, Hutter MM, Khuri SF, Henderson WG (2007) Use of national surgical quality improvement program data as a catalyst for quality improvement. J Am Coll Surg 204(6):1293–1300. doi:10.1016/j.jamcollsurg.2007.03.024 CrossRefPubMed

14.

van Buuren S, Groothuis-Oudshoorn K (2011) mice: Multivariate imputation by chained equations in R. J Stat Softw 45(3):1–67. doi:10.18637/jss.v045.i03 CrossRef

15.

Sullivan LM, Massaro JM, D’Agostino RB Sr (2004) Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med 23(10):1631–1660. doi:10.1002/sim.1742 CrossRefPubMed

16.

James G, Witten D, Hastie T, Tibshirani R (2014) An Introduction to statistical learning: with applications in R. Springer, New York

17.

Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15(4):361–387. doi:10.1002/(SICI)1097-0258(19960229)15:4<361:AID-SIM168>3.0.CO;2-4 CrossRefPubMed

18.

Hosmer DW, Lemeshow S (2004) Applied logistic regression, 2nd edn. Wiley, New York

19.

R Development Core Team (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Home page at: https://www.r-project.org/

20.

Sing T, Sander O, Beerenwinkel N, Lengauer T (2005) ROCR: visualizing classifier performance in R. Bioinformatics 21(20):3940–3941CrossRefPubMed

21.

Harrell FE Jr (2016) rms: regression modeling strategies. Available online at: https://cran.r-project.org/package=rms

22.

Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO et al (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 295(3):285–292. doi:10.1001/jama.295.3.285 CrossRefPubMed

23.

Alimoglu O, Kaya B, Okan I et al (2006) Femoral hernia: a review of 83 cases. Hernia 10(1):70–73. doi:10.1007/s10029-005-0045-3 CrossRefPubMed

24.

Nilsson H, Stylianidis G, Haapamäki M, Nilsson E, Nordin P (2007) Mortality after groin hernia surgery. Ann Surg 245(4):656–660. doi:10.1097/01.sla.0000251364.32698.4b CrossRefPubMedPubMedCentral

25.

Andrews NJ (1981) Presentation and outcome of strangulated external hernia in a district general hospital. Br J Surg 68(5):329–332. http://www.ncbi.nlm.nih.gov/pubmed/7225757, accessed April 4, 2016CrossRefPubMed

26.

Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25(4):835–839. doi:10.1093/ije/25.4.835 CrossRefPubMed

27.

Martínez-Serrano MA, Pereira JA, Sancho JJ, López-Cano M, Bombuy E, Hidalgo J; Study Group of Abdominal Hernia Surgery of the Catalan Society of Surgery (2010) Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg/Dtsch Gesellschaft Chir 395(5):551–556. doi:10.1007/s00423-009-0515-7 CrossRef

28.

Hernández-Irizarry R, Zendejas B, Ramirez T et al (2012) Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia 16(4):397–403. doi:10.1007/s10029-012-0926-1 CrossRefPubMedPubMedCentral

29.

Carbonell AM, Wolfe LG, DeMaria EJ (2005) Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients. Hernia 9(4):353–357. doi:10.1007/s10029-005-0022-x CrossRefPubMed

30.

Eker HH, van Ramshorst GH, de Goede B et al (2011) A prospective study on elective umbilical hernia repair in patients with liver cirrhosis and ascites. Surgery 150(3):542–546. doi:10.1016/j.surg.2011.02.026 CrossRefPubMed

31.

Raymond DP, Crabtree TD, Pelletier SJ et al (2000) Extremes of white blood cell count do not independently predict outcome among surgical patients with infection. Am Surg 66(12):1124–1130; discussion 1130–1

32.

Rørbaek-Madsen M (1992) Herniorrhaphy in patients aged 80 years or more. A prospective analysis of morbidity and mortality. Eur J Surg 158(11–12):591–594. http://www.ncbi.nlm.nih.gov/pubmed/1363063, accessed April 7, 2016

33.

Martínez-Serrano MA, Pereira JA, Sancho J, Argudo N, López-Cano M, Grande L (2012) Specific improvement measures to reduce complications and mortality after urgent surgery in complicated abdominal wall hernia. Hernia 16(2):171–177. doi:10.1007/s10029-011-0875-0 CrossRefPubMed

34.

Dahlstrand U, Wollert S, Nordin P, Sandblom G, Gunnarsson U (2009) Emergency femoral hernia repair: a study based on a national register. Ann Surg 249(4):672–676. doi:10.1097/SLA.0b013e31819ed943 CrossRefPubMed

Title: Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database
Authors: P. J. Chung
J. S. Lee
S. Tam
A. Schwartzman
M. O. Bernstein
L. Dresner
A. Alfonso
G. Sugiyama
Publication date: 01-06-2017
Publisher: Springer Paris
Published in: Hernia / Issue 3/2017
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-016-1538-y

At a glance: The STEP trials

Springer Medicine

Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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