T. Gavigan1, B. Matthews1, N. Rozario1, C. E. Reinke1 1Carolinas Medical Center,Department Of Surgery,Charlotte, NC, USA 2Carolinas Medical Center,Dickson Advanced Analytics,Charlotte, NC, USA
Introduction: Parastomal hernia is the most common complication after stoma creation. An estimated 120,000 new stomas are created each year. Recent studies report an parastomal hernia incidence approaching 80%, with more than half requiring surgical repair. Parastomal hernias create significant morbidity, including patient discomfort, small bowel obstruction, and need for emergent surgery. Little is known about the rates of parastomal hernia repair over the last 10 years in the United States. We examined national trends in parastomal hernia repair (PHR) in this study, including annual frequency of procedure, patient characteristics, and same-admission complications.
Methods: The 1998-2011 Nationwide Inpatient Sample was used to identify patients who underwent a PHR (ICD-9 PR 4642). PHRs were classified as PHR with concurrent resiting (ICD-9 PR 4643), PHR with concurrent ostomy reversal (ICD-9 4652 or 4651), or primary PHR. Patient age, race, sex, comorbidities and type of insurance were identified. Complications, length of stay (LOS), and mortality were identified. The frequencies of patient characteristics and outcomes were calculated by year and by type of PHR and analyzed to identify trends.
Results: The estimated number of annual parastomal hernia repairs increased from 4,161 to 7,646 (p=<0.01, R2=0.85) for a total of 73,659 repairs. 30% underwent a concurrent stoma reversal and 10% underwent a resiting. The proportion of females undergoing PSHR remained steady (58%). There was an upwards trend in the proportion of privately insured patients (26%-31%, p<0.01) and the number of patients with 3 or more Elixhauser comorbidities (17%-44%, p<0.01). The frequency of reversal increased while the frequency of resiting decreased. LOS remained steady (median 6.3 days) and in-hospital mortality ranged from 1.8-3.9% annually. Mortality and emergency admission status were highest for patients who underwent primary PHR, while the distribution of number of comorbidities was not significantly different between the three groups.
Conclusions: The incidence of parastomal hernia repair nationwide is increasing and more than half of patients undergo primary repair. Although the surgical focus has moved towards prevention, parastomal hernia is a persistent complication of stoma creation. Further exploration is warranted to determine if the observed increase in parastomal hernia repair is related to perceived improved techniques and outcomes, an increasing incidence of parastomal hernia, patient characteristics or other factors.
