Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit. Issue 5 (10th July 2020)

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• Is Part Of: BJS open. Volume 4:Issue 5(2020)
• Page Start: 924
• Page End: 934
• Publication Date: 2020-07-10
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50315
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract : Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. Abstract : This study shows that small bowel obstruction due to abdominal wall hernia is common, typically involves a co‐morbid group of patients and has poor outcomes, including high mortality rates. High mortality from this problem Abstract : Antecedentes: La eventración es una enfermedad quirúrgica frecuente. Algunos pacientes acuden a urgencias por episodios de obstrucción intestinal, incarceración o estrangulación. La obstrucción del intestino delgado ( small bowel obstruction, SBO) es una forma de presentación quirúrgica grave asociada a una morbilidad significativa. El objetivo de este estudio fue describir el tratamiento actual y los resultados de los pacientes con obstrucción herniaria en el Reino Unido identificados a través de la National Audit of Small Bowel Obstruction (NASBO). Métodos: La NASBO recopiló datos de los pacientes adultos tratados por obstrucción del intestino delgado en 131 hospitales del Reino Unido entre enero y marzo de 2017. En este estudio se incluyeron solo los que presentaron una obstrucción por una hernia de la pared abdominal. Se registraron los datos demográficos, la comorbilidad, los estudios de imagen, el tratamiento quirúrgico y los resultados hospitalarios. Se realizó una modelización de los factores asociados con la mortalidad y las complicaciones utilizando el análisis de riesgos proporcionales de Cox y modelos de regresión multivariable. Resultados: De los 2.341 pacientes incluidos en la NASBO, 415 (17, 7%) presentaron una SBO por una hernia. La edad media fue de 71, 2 (DE 13, 9) años, con una comorbilidad moderada (índice de comorbilidad de Charlson 4, 6 (DE 7, 1)). Fueron operados 312/415 (75, 2%). Un total de 198/312 (63, 5%) pacientes precisaron una resección del intestino delgado. Se planteó el tratamiento no quirúrgico en 35/65 (53, 8%) de las hernias paraestomales y en 38/106 (32, 1%) de los pacientes con hernia incisional. La mortalidad hospitalaria fue de 39/415 (9, 4%), siendo más elevada en pacientes con hernia inguinal (17/153 (11, 1%)). El desarrollo de complicaciones fue habitual, de las que destaca la infección del tracto respiratorio inferior en el 16, 3%. El aumento de la edad se asoció con un mayor riesgo de mortalidad (cociente de riesgos instantáneos, hazard ratio, HR 1, 05 (1, 01‐1, 10, P = 0, 009)) y complicaciones (razón de oportunidades, odds ratio, OR 1, 05 (1, 01‐1, 10, P = 0, 009)). Conclusión: la NASBO ha puesto en evidencia los malos resultados en pacientes con SBO por hernia, subrayando la necesidad de iniciativas para mejorarlos.