Does coagulopathy, anticoagulant or antithrombotic therapy matter in incisional hernia repair? Data from the Herniamed Registry

Abstract

BackgroundA considerable number of patients undergoing incisional hernia repair are on anticoagulant or antiplatelet therapy or have existing coagulopathy which may put them at higher risk for postoperative bleeding complications. Data about the optimal treatment of these patients are sparse. This analysis attempts to determine the rate of postoperative bleeding complications following incisional hernia repair and the consecutive rate of reoperation among patients with coagulopathy or receiving antiplatelet and anticoagulant therapy (higher risk group) compared to patients who do not have a higher risk (normal risk group).MethodsOut of the 43,101 patients documented in the Herniamed Registry who had an incisional hernia repair, 6668 (15.5%) were on anticoagulant or antithrombotic therapy or had existing coagulopathy. The implication of that higher risk profile for onset of postoperative bleeding was investigated in multivariable analysis. Hence, other influential variables were identified.ResultsThe rate of postoperative bleeding in the higher risk group was 3.9% (n = 261) and significantly higher compared to the normal risk group at 1.6% (n = 564) (OR 2.001 [1.699; 2.356]; p < 0.001). Additionally, male gender, use of drains, larger defect size, open incisional hernia repair, lower BMI, and higher ASA score significantly increased the risk of postoperative bleeding. The rate of reoperations due to postoperative bleeding was significantly increased in the higher risk group compared to the normal risk group (2.4 vs. 1.0%; OR 1.217 [1.071; 1.382]; p = 0.003). Likewise, the postoperative general complication rate (6.04 vs. 3.66%; p < 0.001) as well as the mortality rate (0.46 vs. 0.17%; p < 0.001) were significantly higher in the higher risk group.ConclusionsPatients with anticoagulant or antiplatelet therapy or existing coagulopathy who undergo incisional hernia repair have a significantly higher risk for onset of postoperative bleeding. The risk of bleeding complications and complication-related reoperations seems to be lower after laparoscopic intraperitoneal onlay mesh.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6127-y) contains supplementary material, which is available to authorized users.

Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

“…This finding is clinically relevant since larger hernia sizes require more advanced procedures such as component separation to implant larger mesh sizes [ 16 , 17 ]. Based on the grip calculations given previously [ 8 ], an internet-based application called Stronghold was added to Herniamed, the German-wide registry used for clinical outcome evaluation of ventral hernia repair [ 8 , 19 , 20 ]. First results show that both MDAR and grip tend to fall with increasing hernia sizes in this clinical registry ( Fig.…”

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

“…Other potential risk factors for an unfavorable outcome in hernia surgery are chronic obstructive pulmonary disease, diabetes, aortic aneurysm, immunosuppression, corticosteroid treatment, smoking, coagulopathy, antiplatelet medication and anticoagulation therapy [44,46,[51][52][53].…”

“…In inguinal hernia these risk factors have a recognized negative influence on the postoperative complication rates as well as the complication-related reoperation rates [46]. Likewise, in incisional hernia repair the negative impact of risk factors on the postoperative complication rates have also been clearly demonstrated [53].…”

A Comparative Efficacy Evaluation of Recombinant Topical Thrombin (RECOTHROM®) With A Gelatin Sponge Carrier Versus Topical Oxidized Regenerated Cellulose (TABOTAMP®/SURGICEL®) In A Porcine Liver Bleeding Model

“…5,6 However, patients with coagulopathy (either prior to, or developed during surgery) are at much greater risk of experiencing bleeding complications, regardless of surgical technique. 7,8 Topical hemostatic agents can be used to supplement coagulation and prevent or control bleeding. Time to hemostasis is an important efficacy measure for hemostatic agents, as shorter times not only result in better clinical outcomes 4,9 but also save hospital resources in terms of reduced blood product use, 4 reduced operating times, 10 shorter duration of hospital stay 9 and reduced likelihood of needing to apply additional hemostatic agents.…”