High bilirubin and blood urea nitrogen predict intestinal necrosis in incarcerated groin hernia.

PURPOSE: Groin hernias are one of the most common surgical conditions worldwide, leading to substantial numbers of incarcerated cases. Incarcerated hernias pose a potential bowel necrosis risk, complicating surgical decision-making. Therefore, preoperative prediction of intestinal necrosis is crucial for determining treatment strategies. While previous studies on intestinal necrosis primarily focused on adhesive obstruction, few addressed incarcerated hernias. This study investigated risk factors for intestinal necrosis using electronic medical records.

METHODS

Patients with incarcerated groin hernias who underwent emergency surgery at our institution between April 2017 and May 2025 were included. Comprehensive patient data were evaluated for their association with bowel resection. Following univariate analysis, multivariable analysis was performed focusing on factors with the strongest correlations. Odds ratios, risk ratios, and risk differences were calculated. Risk factor nonlinearity was assessed via restricted cubic splines.

RESULTS

One-hundred fifteen patients (median age 79.0 years; interquartile range, 71.0–87.0 years) were included. Bowel resection was performed in 25 patients (22%). Comprehensive univariate analysis identified multiple significant factors including blood urea nitrogen (BUN) and total bilirubin (T-Bil), showing strongest correlations. Multivariable analysis revealed BUN and T-Bil were independent prognostic factors (BUN: OR 1.55 (1.01, 2.37), RR 1.20 (1.06, 1.35), RD 7.5 (2.0, 13.0); T-Bil: OR 31.22 (5.69, 171.35), RR 6.31 (3.36, 11.84), RD 46.6 (28.7, 64.4)). Restricted cubic spline analysis revealed BUN nonlinearity with increased slope above 18 mg/dL (LRT p = 0.001), while no T-Bil nonlinearity was observed (LRT p = 0.398).

CONCLUSION

Elevated preoperative T-Bil and BUN levels are associated with intestinal necrosis and serve as useful indicators for determining treatment strategies.