Umbilical herniorrhapy in cirrhosis

Improved outcomes with elective repair

Stephen H. Gray, Catherine C. Vick, Laura A. Graham, Kelly R. Finan, Leigh A Neumayer, Mary T. Hawn

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes. Procedures were identified from the Veterans' Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical records and operative reports were physician abstracted to obtain preoperative and intraoperative variables. Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%, p∈<∈0.0001), concomitant bowel resection (8.7% vs. 0.8%, p∈<∈0.0001), return to operating room (7.9% vs. 2.5%, p∈=∈0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p∈=∈0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant predictors of complications were emergent case (OR 5.4; 95% CI 3.1-9.4), diabetes (OR 2.1; 95% CI 1.2-3.8), congestive heart failure (OR 4.0; 95% CI 1.4-11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1-3.6). Among emergent repairs, cirrhosis (OR 4.4; 95% CI 1.3-14.3) was strongly associated with postoperative complications. Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)675-681
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Umbilicus
Fibrosis
Veterans
Operating Rooms
Quality Improvement
Chronic Obstructive Pulmonary Disease
Medical Records
Length of Stay
Heart Failure
Physicians

Keywords

  • Case status
  • Cirrhosis
  • Outcomes
  • Umbilical hernia

ASJC Scopus subject areas

  • Surgery

Cite this

Umbilical herniorrhapy in cirrhosis : Improved outcomes with elective repair. / Gray, Stephen H.; Vick, Catherine C.; Graham, Laura A.; Finan, Kelly R.; Neumayer, Leigh A; Hawn, Mary T.

In: Journal of Gastrointestinal Surgery, Vol. 12, No. 4, 04.2008, p. 675-681.

Research output: Contribution to journalArticle

Gray, Stephen H. ; Vick, Catherine C. ; Graham, Laura A. ; Finan, Kelly R. ; Neumayer, Leigh A ; Hawn, Mary T. / Umbilical herniorrhapy in cirrhosis : Improved outcomes with elective repair. In: Journal of Gastrointestinal Surgery. 2008 ; Vol. 12, No. 4. pp. 675-681.
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abstract = "This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes. Procedures were identified from the Veterans' Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical records and operative reports were physician abstracted to obtain preoperative and intraoperative variables. Of the 1,421 cases reviewed, 127 (8.9{\%}) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0{\%} vs. 4.8{\%}, p∈<∈0.0001), concomitant bowel resection (8.7{\%} vs. 0.8{\%}, p∈<∈0.0001), return to operating room (7.9{\%} vs. 2.5{\%}, p∈=∈0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p∈=∈0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant predictors of complications were emergent case (OR 5.4; 95{\%} CI 3.1-9.4), diabetes (OR 2.1; 95{\%} CI 1.2-3.8), congestive heart failure (OR 4.0; 95{\%} CI 1.4-11.4), and chronic obstructive pulmonary disease (OR 2.0; 95{\%} CI 1.1-3.6). Among emergent repairs, cirrhosis (OR 4.4; 95{\%} CI 1.3-14.3) was strongly associated with postoperative complications. Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis.",
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