P.L. Johnson1, R.A. Jean1, M.R. Hemmila1 1University of Michigan, Surgery, Ann Arbor, MI, USA
Introduction: Emergent repair of incarcerated or strangulated hernias carries a potential increased risk of mortality and morbidity when compared to elective hernia repair. Recent trends in elective hernia repair have emphasized appropriate patient selection and preoperative optimization. We investigated the role of prior established care by a surgeon in emergent hernia repair.
Methods: This study used data from a state-wide Acute Care Surgery collaborative from January 2022 to May 2024. Patients undergoing emergent operative intervention which included a hernia repair were included and stratified by prior established hernia care with a surgeon. Patient characteristics and hernia specific variables were compared between cohorts using bivariate analysis, and clinical outcomes were compared using multivariable regression. Established hernia care was evaluated via multisystem electronic medical record review.
Results: 632 patients were identified, of which 200 (31.6%) had previously established hernia care with a surgeon. These patients were more likely to be younger, male, non-white, on Medicaid, smokers, diabetic, and have an opioid prescription (all p<0.05) (Figure). These patients had larger hernias (5.0 vs 4.0cm, p<0.001) and were more likely to be recurrent (34.5 vs 23.6%, p=0.004). Established hernia care was not associated with mortality or complications, but it was inversely associated with receiving a mesh repair (43.5 vs 57.6%, p<0.001).
Conclusion: Nearly one third of patients undergoing exploratory laparotomy for hernia emergencies have previously been evaluated by a surgeon. While this population may not have been appropriate for elective hernia repair, the other two thirds may represent a gap in surgical access that substantially contributes to the overall burden of hernia morbidity in the emergency general surgery setting.