Risk Factors for Bad Outcomes in Incisional Hernia Repair: Lessons Learned From the National Registry of Incisional Hernia (EVEREG)

Pereira, José António; Montcusí, Blanca; López‐Cano, Manuel; Hernández-Granados, Pilar; Prado, Laura Fresno de

doi:10.1016/j.cireng.2018.07.015

Cited by 11 publications

(20 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, a higher percentage of patients in the AWS group had a previous hernia repair and higher transversal and longitudinal diameters. Both factors point to a higher probability of recurrences and complications in this group [28], whereas in our study, the results showed fewer recurrences during follow-up.…”

Section: Discussioncontrasting

confidence: 70%

Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters

et al. 2019

View full text Add to dashboard Cite

Background Recurrence after incisional hernia repair is one of the major problems related with this operation. Our objective is to analyze the influence of abdominal wall surgery expertise in the results of the open elective repair of incisional hernia. Methods We have compiled the data of a cohort of patients who received surgery for an incisional hernia from July 2012 to December 2015 in a University Hospital. Data were collected prospectively and registered in the Spanish Register of Incisional Hernia (EVEREG). The short- and long-term complications between the groups of patients operated on by the Abdominal Wall Surgery (AWS) unit and groups operated on by surgeons outside of the specialized abdominal wall group (GS) were compared. Results During the study period, a total of 237 patients were operated on by the open approach (114 AWS; 123 GS). One hundred seventy-five patients completed a median follow-up of 36.6 months [standard deviation (SD) = 6]. Groups were comparable in terms of age, sex, body mass index (BMI), comorbidities, and complexity of hernia. Complications were similar in both groups. Patients in the AWS group presented fewer recurrences (12.0% vs. 28.9%; P = 0.005). The cumulative incidence of recurrence was higher in the GS group [log rank 13.370; P < 0.001; odds ratio (OR) = 37.8; 95% confidence interval (CI) = 30.3–45.4]. In the multivariate analysis, surgery performed by the AWS unit was related to fewer recurrences (OR = 0.19; 95%CI = 0.07–0.58; P < 0.001). Conclusion Incisional hernia surgery is associated with better results in terms of recurrence when it is performed in a specialized abdominal wall unit.

show abstract

Section: Discussioncontrasting

confidence: 70%

Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters

et al. 2019

View full text Add to dashboard Cite

show abstract

“…More than half of the identified studies included in this review failed to report co-morbid status, BMI, ASA grade, smoking status and steroid use. These important parameters are recognized risk factors for adverse events in incisional hernia repair 110–112 and help decision making and risk stratification when considering the optimal operative strategy in incisional hernia repair. The lack of detail regarding patient physiology and co-morbid status fails to provide clear guidance on patient selection, thus limiting the clinical application of the obtained results, and further contributing to the heterogeneity observed in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of outcome reporting in incisional hernia surgery

et al. 2021

View full text Add to dashboard Cite

Background The incidence of incisional hernia is up to 20 per cent after abdominal surgery. The management of patients with incisional hernia can be complex with an array of techniques and meshes available. Ensuring consistency in reporting outcomes across studies on incisional hernia is important and will enable appropriate interpretation, comparison and data synthesis across a range of clinical and operative treatment strategies. Methods Literature searches were performed in MEDLINE and EMBASE (from 1 January 2010 to 31 December 2019) and the Cochrane Central Register of Controlled Trials. All studies documenting clinical and patient-reported outcomes for incisional hernia were included. Results In total, 1340 studies were screened, of which 92 were included, reporting outcomes on 12 292 patients undergoing incisional hernia repair. Eight broad-based outcome domains were identified, including patient and clinical demographics, hernia-related symptoms, hernia morphology, recurrent incisional hernia, operative variables, postoperative variables, follow-up and patient-reported outcomes. Clinical outcomes such as hernia recurrence rates were reported in 80 studies (87 per cent). A total of nine different definitions for detecting hernia recurrence were identified. Patient-reported outcomes were reported in 31 studies (34 per cent), with 18 different assessment measures used. Conclusions This review demonstrates the significant heterogeneity in outcome reporting in incisional hernia studies, with significant variation in outcome assessment and definitions. This is coupled with significant under-reporting of patient-reported outcomes.

show abstract

“…The analysis of this series shows that CST is a complex operation, mostly performed in high-risk patients with large major complex hernias, which frequently requires associated procedures and has a high risk of complications. Recurrences are comparable to those with the other techniques [12], but when the operation is performed in an elective setting, with a mesh and by an AWU, the rate of recurrences is lower. In our series, patients undergoing CST were an aged population with a high proportion of obesity (30.3 kg/m 2 average BMI) and other comorbidities; one-third of these patients were classified as ASA III or IV, which has been shown to contribute to worse outcomes.…”

Section: Discussionmentioning

confidence: 66%

“…Demographic variables, including patient's age, gender, and body mass index (BMI), obesity, and overweight following WHO classification [14] were collected. Comorbidities selected were hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure, oncologic history, abdominal aortic aneurysm, and American Society of Anesthesiologists' (ASA) physical status score [12].…”

Section: Variablesmentioning

confidence: 99%

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Rodríguez

Bravo-Salvá

Montcusí-Ventura

et al. 2021

Hernia

View full text Add to dashboard Cite

Aim To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients. Methods All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed. Results During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m2. ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64–14.65; P = 0.004). Conclusion CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.

show abstract

Risk Factors for Bad Outcomes in Incisional Hernia Repair: Lessons Learned From the National Registry of Incisional Hernia (EVEREG)

Cited by 11 publications

References 17 publications

Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters

Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters

A systematic review of outcome reporting in incisional hernia surgery

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Contact Info

Product

Resources

About