Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

Abstract

The goal of this study was to identify risk factors that are associated with mortality in adult and elderly patients who were hospitalized for umbilical hernia. A total of 14,752 adult patients (ages 18–64 years) and 6490 elderly patients (ages 65+), who were admitted emergently for umbilical hernia, were included in this retrospective cohort study. The data were gathered from the National Inpatient Sample (NIS) 2005–2014 database. Predictors of mortality were identified via a multivariable logistic regression, in patients who underwent surgery and those who did not for adult and elderly age groups. The mean (SD) ages for adult males and females were 48.95 (9.61) and 46.59 (11.35) years, respectively. The mean (SD) ages for elderly males and females were 73.62 (6.83) and 77.31 (7.98) years, respectively. The overall mortality was low (113 or 0.8%) in the adult group and in the elderly group (179 or 2.8%). In adult patients who underwent operation, age (OR = 1.066, 95% CI: 1.040–1.093, p < 0.001) and gangrene (OR = 5.635, 95% CI: 2.288–13.874, p < 0.001) were the main risk factors associated with mortality. Within the same population, female sex was found to be a protective factor (OR = 0.547, 95% CI: 0.351–0.854, p = 0.008). Of the total adult sample, 43% used private insurance, while only 18% of patients in the deceased population used private insurance. Conversely, within the entire adult population, only about 48% of patients used Medicare, Medicaid, or self-pay, while these patients made up 75% of the deceased group. In the elderly surgical group, the main risk factors significantly associated with mortality were frailty (OR = 1.284, 95% CI: 1.105–1.491, p = 0.001), gangrene (OR = 13.914, 95% CI: 5.074–38.154, p < 0.001), and age (OR = 1.034, 95% CI: 1.011–1.057, p = 0.003). In the adult non-operation group, hospital length of stay (HLOS) was a significant risk factor associated with mortality (OR = 1.077, 95% CI: 1.004–1.155, p = 0.038). In the elderly non-operation group, obstruction was the main risk factor (OR = 4.534, 95% CI: 1.387–14.819, p = 0.012). Elderly patients experienced a 3.5-fold higher mortality than adult patients who were emergently admitted with umbilical hernia. Increasing age was a significant risk factor of mortality within all patient populations. In the adult surgical group, gangrene, Medicare, Medicaid, and self-pay were significant risk factors of mortality and female sex was a significant protective factor. In the adult non-surgical group, HLOS was the main risk factor of mortality. In the elderly population, frailty and gangrene were the main risk factors of mortality within the surgical group, and obstruction was the main risk factor for the non-surgical group.

Emergency umbilical hernia management: scoping review

“…Most were retrospective cohort designs (11/14), equally split between single (6/14) and multicentre (8/14) with only one RCT. Most multicentre studies were from national databases (7/8): the National Surgical Quality Improvement Program (NSQIP) 2 , 10 , 11 , the National Inpatient Sample (NIS) 12 , 13 , the Swedish National Patient Register 14 , and the Danish Hernia Database 15 .…”

Successful Repair With Strategic Omentectomy and Meticulous Suturing for Incarcerated Massive Umbilical Hernia in an Adult: A Case Report

“…The International Endohernia Society (IEHS) guidelines state umbilical hernias obstruct five times more often than other ventral and incisional hernias, with emergency repairs associated with high morbidity [ 3 ]. Elderly patients face a 3.5-fold higher emergency surgery mortality rate than adults [ 4 ]. A notable case involved massive colon gangrene due to a strangulated umbilical hernia [ 2 ].…”

Elderly Patients Managed Non-Operatively with Abscesses of the Anorectal Region Have Five Times Higher Rate of Mortality Compared to Non-Elderly

“…Longer hospital length of stay has been shown to be detrimental in many diverse conditions [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 30 , 33 , 34 ]. Interestingly, for patients with ruptured abdominal aortic aneurysm, longer hospital length of stay was inversely correlated with mortality and thus improved outcomes [ 35 ].…”

“…The database was created by AHRQ (the Agency for Healthcare Research and Quality), which has been frequently used nationally as a public data source for analysis of variegated types and qualities of patient care and their associated results. This has allowed us to perform a comprehensive and holistic path to research diseases, a path to the ideal way to treat and care for patients with those diseases, and ultimately a path to find how patients respond to both the diseases and treatments [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The NIS database includes certain weighting when constructing its sample of discharges and it excludes long-term acute care facilities and rehabilitation centers.…”