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Emergency hernia surgery at a high‐volume tertiary centre: a 3‐year experience
Author(s) -
Russell Thomas B.,
Elberm Hassan
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.16597
Subject(s) - medicine , intensive care unit , surgery , bowel resection , hernia , emergency surgery , complication , retrospective cohort study , demographics , mortality rate , incisional hernia , general surgery , abdominal surgery , demography , sociology
Background Hernia surgery is often considered minor. However, emergency abdominal wall hernia (AWH) surgery is associated with significant morbidity. This study reviews a high‐volume centre's experience. Methods This is a retrospective review of all emergency AWH operations performed between 2014 and 2017. The following were analysed: patient demographics, ASA grade, type of hernia, time from admission to surgery, use of pre‐operative imaging, sac content, details of bowel resection, rate of admission to high dependency unit (HDU)/intensive care unit (ICU), length of stay and morbidity/mortality. Results A total of 198 cases were included. Median age was 67.4 years (range 19–95). 52.2% of patients were ASA III or above. Median time from admission to surgery was 13 h (range 1–341) and median length of stay was 4 days (range 1–75). The sac contained bowel in 93 cases (47.0%). These patients had longer length of stay ( P < 0.01) and were more frequently admitted to HDU/ICU ( P < 0.01). Thirty‐one patients underwent bowel resection (33.3% of those with bowel involvement and 15.7% of the total). Twenty‐seven patients (13.6%) were admitted to HDU/ICU post‐operatively. Six patients (3.0%) had an unplanned return to theatre and 66 patients (33.3%) had a post‐operative complication. Inpatient mortality was three (1.51%). Conclusions Patients who undergo emergency AWH surgery represent a relatively aged and co‐morbid group. This surgery is associated with significant morbidity and consumes considerable hospital resources. Efforts should be made to identify the higher risk subgroup with bowel involvement. Elderly and co‐morbid patients should be listed for timely elective surgery wherever suitable.