F Drissi1, J F Gillion2, J P Cossa3, F Jurczak4, C Baayen5. 1. Clinique de chirurgie digestive et endocrinienne (CCDE), Institut des maladies de l'appareil digestif (IMAD), Hôtel Dieu, CHU de Nantes, place Ricordeau, 44093 Nantes cedex 1, France. Electronic address: farouk.drissi@gmail.com. 2. Unité de chirurgie viscérale et digestive, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France. 3. Chirurgie générale et digestive, CMC Georges-Bizet, 23, rue Georges-Bizet, 75116 Paris, France. 4. Chirurgie générale et digestive, clinique mutualiste de l'estuaire, cité sanitaire, 11, boulevard Georges-Charpak, 44606 Saint-Nazaire, France. 5. Capionis, 183 avenue de Choisy, 75013 Paris, France.
Abstract
BACKGROUND: Ambulatory surgery for incisional hernia repair (IHR) is not a widespread practice and is mainly performed for small incisional hernias. AIM: To assess outpatient IHR practice in France and to identify predictive factors of selection and failure of ambulatory procedures. METHOD: Surgeons of the French "Club Hernie" prospectively gathered data concerning IHR over a period of almost 5years within a nationwide database. RESULTS: A number of patients (1429) were operated on during the period of the study. The mean age was 63.3 (22-97) years old. An ambulatory procedure was planned in 305 (21%) patients. Among these, 272 (89%) IHR were effectively performed as one-day procedures. Upon multivariate analysis, predictive factors influencing practitioners for not propose an ambulatory care were increasing age (OR 0.97, P<0.001), body mass index (OR 0.95, P<0.001), ASA grade≥III (OR 0.23, P<0.001), hernia width≥4cm (OR 0.44, P<0.001), recurrent hernia (OR 0.55, P=0.01) and a laparoscopic IHR (OR 0.54, P<0.001). A number of patients (1157) were not selected preoperatively for outpatient IHR mainly because of organizational issues or an ASA grade≥III. Medical or social reasons were the main causes of failure of initially planned ambulatory settings. CONCLUSION: Ambulatory IHR is a safe and feasible practice subject to a good preoperative selection of the patients. Increasing age, body mass index, ASA grade≥III, hernia width≥4cm, recurrent hernia and a laparoscopic IHR were identified to be preoperative factors for not proposing an ambulatory care. One-day surgery for IHR could be systematically proposed for IHR of small incisional hernias (<4cm) in young patients with few comorbidities.
BACKGROUND: Ambulatory surgery for incisional hernia repair (IHR) is not a widespread practice and is mainly performed for small incisional hernias. AIM: To assess outpatient IHR practice in France and to identify predictive factors of selection and failure of ambulatory procedures. METHOD: Surgeons of the French "Club Hernie" prospectively gathered data concerning IHR over a period of almost 5years within a nationwide database. RESULTS: A number of patients (1429) were operated on during the period of the study. The mean age was 63.3 (22-97) years old. An ambulatory procedure was planned in 305 (21%) patients. Among these, 272 (89%) IHR were effectively performed as one-day procedures. Upon multivariate analysis, predictive factors influencing practitioners for not propose an ambulatory care were increasing age (OR 0.97, P<0.001), body mass index (OR 0.95, P<0.001), ASA grade≥III (OR 0.23, P<0.001), hernia width≥4cm (OR 0.44, P<0.001), recurrent hernia (OR 0.55, P=0.01) and a laparoscopic IHR (OR 0.54, P<0.001). A number of patients (1157) were not selected preoperatively for outpatient IHR mainly because of organizational issues or an ASA grade≥III. Medical or social reasons were the main causes of failure of initially planned ambulatory settings. CONCLUSION: Ambulatory IHR is a safe and feasible practice subject to a good preoperative selection of the patients. Increasing age, body mass index, ASA grade≥III, hernia width≥4cm, recurrent hernia and a laparoscopic IHR were identified to be preoperative factors for not proposing an ambulatory care. One-day surgery for IHR could be systematically proposed for IHR of small incisional hernias (<4cm) in young patients with few comorbidities.
Authors: C Stabilini; G Cavallaro; P Dolce; S Capoccia Giovannini; F Corcione; M Frascio; M Sodo; G Merola; U Bracale Journal: Hernia Date: 2019-09-23 Impact factor: 4.739
Authors: Nadine van Veenendaal; Marijn M Poelman; Baukje van den Heuvel; Boudewijn J Dwars; W Hermien Schreurs; Jan H M B Stoot; H Jaap Bonjer Journal: Surg Endosc Date: 2018-11-14 Impact factor: 4.584