Delay in emergency hernia surgery is associated with worse outcomes

Ira L. Leeds, Christian Jones, Sandra R. DiBrito, Joseph V. Sakran, Elliott R. Haut, Alistair J. Kent

Research output: Contribution to journalArticle

Abstract

Background: Patients requiring emergent surgery for hernia vary widely in presentation and management. The purpose of this study was to determine if the variation in timing of urgent surgery impacts surgical outcomes. Methods: The national NSQIP database for years 2011–2016 was queried for emergent surgeries for abdominal hernia resulting in obstruction or gangrene by primary post-op diagnosis. Diaphragmatic hernias were excluded. Patients were grouped by surgical timing from admission to day of surgery: same day, next day, and longer delay. Multinomial propensity score weighting was used to address potential differences in underlying covariates’ clustering across the timing groups followed by multivariable logistic regression of morbidity and mortality. Results: Weighted analysis yielded an effective sample size of 76,364. Hernia types included inguinal (20.9%); femoral (6.7%); umbilical (20.2%); ventral (41.0%); and other (10.4%). Delayed surgery was associated with increased rates of major complications (26.4% vs. 20.9%, p < 0.001), longer operative times (+ 12.5 min, p < 0.001), longer postoperative lengths of stay (+ 1.6 days, p < 0.001), increased re-operations (5.9% vs. 4.7%, p = 0.019), increased readmissions (7.0% vs. 5.7%, p = 0.004), and increased 30-day mortality (2.4% vs. 1.7%, p = 0.002). When controlling for other factors, next-day surgery (OR 1.23, 95% CI 1.05–1.45, p = 0.009) and surgery delayed more than one day (OR 1.40, 95% CI 1.13–1.73, p < 0.002) were associated with an increased odds of a major complication. Mortality and readmission by timing of surgery were not independently significant. Conclusions: Delay in surgery for emergent hernias increased the odds of major morbidity but not mortality. Patients presenting with hernia and an indication for urgent surgical intervention may benefit from an operation as soon as feasible rather than warrant waiting for further physiologic optimization, medical clearance, or specialized surgical personnel.

Original languageEnglish (US)
JournalSurgical endoscopy
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Hernia
Emergencies
Mortality
Ambulatory Surgical Procedures
Abdominal Hernia
Morbidity
Umbilicus
Propensity Score
Diaphragmatic Hernia
Gangrene
Inguinal Hernia
Operative Time
Thigh
Sample Size
Cluster Analysis
Length of Stay
Logistic Models
Databases

Keywords

  • Emergency General Surgery
  • Hernia
  • NSQIP
  • Obstruction
  • Perioperative care
  • Propensity score

ASJC Scopus subject areas

  • Surgery

Cite this

Delay in emergency hernia surgery is associated with worse outcomes. / Leeds, Ira L.; Jones, Christian; DiBrito, Sandra R.; Sakran, Joseph V.; Haut, Elliott R.; Kent, Alistair J.

In: Surgical endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Delay in emergency hernia surgery is associated with worse outcomes",
abstract = "Background: Patients requiring emergent surgery for hernia vary widely in presentation and management. The purpose of this study was to determine if the variation in timing of urgent surgery impacts surgical outcomes. Methods: The national NSQIP database for years 2011–2016 was queried for emergent surgeries for abdominal hernia resulting in obstruction or gangrene by primary post-op diagnosis. Diaphragmatic hernias were excluded. Patients were grouped by surgical timing from admission to day of surgery: same day, next day, and longer delay. Multinomial propensity score weighting was used to address potential differences in underlying covariates’ clustering across the timing groups followed by multivariable logistic regression of morbidity and mortality. Results: Weighted analysis yielded an effective sample size of 76,364. Hernia types included inguinal (20.9{\%}); femoral (6.7{\%}); umbilical (20.2{\%}); ventral (41.0{\%}); and other (10.4{\%}). Delayed surgery was associated with increased rates of major complications (26.4{\%} vs. 20.9{\%}, p < 0.001), longer operative times (+ 12.5 min, p < 0.001), longer postoperative lengths of stay (+ 1.6 days, p < 0.001), increased re-operations (5.9{\%} vs. 4.7{\%}, p = 0.019), increased readmissions (7.0{\%} vs. 5.7{\%}, p = 0.004), and increased 30-day mortality (2.4{\%} vs. 1.7{\%}, p = 0.002). When controlling for other factors, next-day surgery (OR 1.23, 95{\%} CI 1.05–1.45, p = 0.009) and surgery delayed more than one day (OR 1.40, 95{\%} CI 1.13–1.73, p < 0.002) were associated with an increased odds of a major complication. Mortality and readmission by timing of surgery were not independently significant. Conclusions: Delay in surgery for emergent hernias increased the odds of major morbidity but not mortality. Patients presenting with hernia and an indication for urgent surgical intervention may benefit from an operation as soon as feasible rather than warrant waiting for further physiologic optimization, medical clearance, or specialized surgical personnel.",
keywords = "Emergency General Surgery, Hernia, NSQIP, Obstruction, Perioperative care, Propensity score",
author = "Leeds, {Ira L.} and Christian Jones and DiBrito, {Sandra R.} and Sakran, {Joseph V.} and Haut, {Elliott R.} and Kent, {Alistair J.}",
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T1 - Delay in emergency hernia surgery is associated with worse outcomes

AU - Leeds, Ira L.

AU - Jones, Christian

AU - DiBrito, Sandra R.

AU - Sakran, Joseph V.

AU - Haut, Elliott R.

AU - Kent, Alistair J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Patients requiring emergent surgery for hernia vary widely in presentation and management. The purpose of this study was to determine if the variation in timing of urgent surgery impacts surgical outcomes. Methods: The national NSQIP database for years 2011–2016 was queried for emergent surgeries for abdominal hernia resulting in obstruction or gangrene by primary post-op diagnosis. Diaphragmatic hernias were excluded. Patients were grouped by surgical timing from admission to day of surgery: same day, next day, and longer delay. Multinomial propensity score weighting was used to address potential differences in underlying covariates’ clustering across the timing groups followed by multivariable logistic regression of morbidity and mortality. Results: Weighted analysis yielded an effective sample size of 76,364. Hernia types included inguinal (20.9%); femoral (6.7%); umbilical (20.2%); ventral (41.0%); and other (10.4%). Delayed surgery was associated with increased rates of major complications (26.4% vs. 20.9%, p < 0.001), longer operative times (+ 12.5 min, p < 0.001), longer postoperative lengths of stay (+ 1.6 days, p < 0.001), increased re-operations (5.9% vs. 4.7%, p = 0.019), increased readmissions (7.0% vs. 5.7%, p = 0.004), and increased 30-day mortality (2.4% vs. 1.7%, p = 0.002). When controlling for other factors, next-day surgery (OR 1.23, 95% CI 1.05–1.45, p = 0.009) and surgery delayed more than one day (OR 1.40, 95% CI 1.13–1.73, p < 0.002) were associated with an increased odds of a major complication. Mortality and readmission by timing of surgery were not independently significant. Conclusions: Delay in surgery for emergent hernias increased the odds of major morbidity but not mortality. Patients presenting with hernia and an indication for urgent surgical intervention may benefit from an operation as soon as feasible rather than warrant waiting for further physiologic optimization, medical clearance, or specialized surgical personnel.

AB - Background: Patients requiring emergent surgery for hernia vary widely in presentation and management. The purpose of this study was to determine if the variation in timing of urgent surgery impacts surgical outcomes. Methods: The national NSQIP database for years 2011–2016 was queried for emergent surgeries for abdominal hernia resulting in obstruction or gangrene by primary post-op diagnosis. Diaphragmatic hernias were excluded. Patients were grouped by surgical timing from admission to day of surgery: same day, next day, and longer delay. Multinomial propensity score weighting was used to address potential differences in underlying covariates’ clustering across the timing groups followed by multivariable logistic regression of morbidity and mortality. Results: Weighted analysis yielded an effective sample size of 76,364. Hernia types included inguinal (20.9%); femoral (6.7%); umbilical (20.2%); ventral (41.0%); and other (10.4%). Delayed surgery was associated with increased rates of major complications (26.4% vs. 20.9%, p < 0.001), longer operative times (+ 12.5 min, p < 0.001), longer postoperative lengths of stay (+ 1.6 days, p < 0.001), increased re-operations (5.9% vs. 4.7%, p = 0.019), increased readmissions (7.0% vs. 5.7%, p = 0.004), and increased 30-day mortality (2.4% vs. 1.7%, p = 0.002). When controlling for other factors, next-day surgery (OR 1.23, 95% CI 1.05–1.45, p = 0.009) and surgery delayed more than one day (OR 1.40, 95% CI 1.13–1.73, p < 0.002) were associated with an increased odds of a major complication. Mortality and readmission by timing of surgery were not independently significant. Conclusions: Delay in surgery for emergent hernias increased the odds of major morbidity but not mortality. Patients presenting with hernia and an indication for urgent surgical intervention may benefit from an operation as soon as feasible rather than warrant waiting for further physiologic optimization, medical clearance, or specialized surgical personnel.

KW - Emergency General Surgery

KW - Hernia

KW - NSQIP

KW - Obstruction

KW - Perioperative care

KW - Propensity score

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