Clinical outcomes vary for emergent and elective ventral hernia repair

Abstract

PURPOSE: Elective ventral hernia repair (ELVHR) is generally performed for chronic symptoms, including pain, increasing size, intermittent obstruction, and cosmesis. Emergent ventral hernia repair (EMVHR) indications include acute symptoms that are often concerning for strangulation. The study objective included identifying variations in perioperative characteristics as well as clinical and cost outcomes in patients who underwent ELVHR vs. EMVHR. MATERIALS AND METHODS: An IRB-approved retrospective review of ELVHR and EMVHR cases was conducted, exclusive of incidental hernias. Due to the retrospective nature of the study, patient consent was deemed unnecessary by the IRB. Demographics, perioperative characteristics, operative details, clinical outcomes, and hospital costs were included in the analyses. RESULTS: Five-hundred forty-nine patients (453 ELVHR, 96 EMVHR) underwent repair. The EMVHR characteristics included more females (P = 0.009), class 3 obesity (P < 0.001), diabetes (P < 0.001), and bleeding disorder (P = 0.009). The EMVHR indications included incarceration (69%), strangulation (12%), and perforation (2%). Fifty-six percent of EMVHR underwent repair without mesh vs. 3.5% of ELVHR. Six-month wound events and ER visits were similar between groups; hernia recurrence was noted in 4% of ELVHR and 17% of EMVHR (P < 0.001). Pharmacy, ICU, lab, ancillary services, floor, and imaging costs varied significantly between groups. Supply, OR, and total hospital costs were similar. CONCLUSIONS: The EMVHR occurs in a unique patient population with more frequent comorbidities. Incarceration and obstruction are the most common indications for repair. Costs were similar despite more frequent non-mesh repairs and four-fold increase early recurrence rates in EMVHR. Strategies to improve outcomes in EMVHR require further investigation.