Clayton C Petro1, Ivy N Haskins2, Arielle J Perez2, Luciano Tastaldi2, Andrew T Strong2, Ramona N Ilie2, Chao Tu3, David M Krpata2, Ajita S Prabhu2, Bijan Eghtesad4, Michael J Rosen2. 1. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: PETROC@CCF.ORG. 2. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA. 3. Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic, Cleveland, OH, USA. 4. Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: Elective hernia repairs in chronic liver disease (CLD) patients are often avoided due to the fear of hepatic decompensation and mortality, leaving the patient susceptible to an emergent presentation. METHODS: CLD patients undergoing ventral or inguinal hernia repair in emergent and non-emergent settings at our institution (2001-2015) were analyzed. Predictors of 30-day morbidity and mortality (M&M) were determined using univariate analysis and multivariate logistic regression. RESULTS: A total of 186 non-emergent repairs identified acceptable rates of M&M (27%) and 90-day mortality (3.7%, 0/21 for MELD≥15). Meanwhile, 67 emergent repairs had higher rates of M&M (60%) and 90-day mortality (10%; 25% for MELD≥15). M&M was associated with elevated MELD scores in emergent cases (14 ± 6 vs 11 ± 4; p = 0.01) and intraoperative drain placement in non-emergent cases (OR1.31,p < 0.01). CONCLUSION: In patients with advanced CLD, non-emergent hernia repairs carry acceptable rates of M&M, while emergent repairs have increased M&M rates associated with higher MELD scores.
BACKGROUND: Elective hernia repairs in chronic liver disease (CLD) patients are often avoided due to the fear of hepatic decompensation and mortality, leaving the patient susceptible to an emergent presentation. METHODS: CLD patients undergoing ventral or inguinal hernia repair in emergent and non-emergent settings at our institution (2001-2015) were analyzed. Predictors of 30-day morbidity and mortality (M&M) were determined using univariate analysis and multivariate logistic regression. RESULTS: A total of 186 non-emergent repairs identified acceptable rates of M&M (27%) and 90-day mortality (3.7%, 0/21 for MELD≥15). Meanwhile, 67 emergent repairs had higher rates of M&M (60%) and 90-day mortality (10%; 25% for MELD≥15). M&M was associated with elevated MELD scores in emergent cases (14 ± 6 vs 11 ± 4; p = 0.01) and intraoperative drain placement in non-emergent cases (OR1.31,p < 0.01). CONCLUSION: In patients with advanced CLD, non-emergent hernia repairs carry acceptable rates of M&M, while emergent repairs have increased M&M rates associated with higher MELD scores.
Authors: Rafael Soares Pinheiro; Wellington Andraus; Daniel Reis Waisberg; Lucas Souto Nacif; Liliana Ducatti; Vinicius Rocha-Santos; Márcio A Diniz; Rubens Macedo Arantes; Jan Lerut; Luiz Augusto Carneiro D'Albuquerque Journal: Ann Med Surg (Lond) Date: 2019-11-22