Hernia : the journal of hernias and abdominal wall surgery · 2025
Correlation between inguinal and ventral hernia repair outcomes and pre-existing comorbidity clusters: ACS-NSQIP study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Wang Wendy, Haq Javairia, Long-Mills Em, Tumin Dmitry, Chumakova-Orin Maryna
Аннотация
PURPOSE: Pre-existing comorbidities may negatively impact surgical outcomes, yet risk profiles based on combinations of comorbidities are underutilized. We aimed to identify comorbidity clusters associated with adverse surgical outcomes after inguinal or ventral hernia repair.
METHODS: We performed a retrospective cohort study using the ACS-NSQIP database (2016-2023). Adults undergoing elective inguinal or ventral hernia repair were identified using CPT and ICD-10 codes. Latent class analysis (LCA) identified subgroups of patients who shared similar patterns of comorbidities. Outcomes included postoperative complications, hospital length of stay, and 30-day mortality.
RESULTS: Among 224,522 patients, LCA identified six profiles: no comorbidities, smoking, bleeding disorder or congestive heart failure (CHF), obesity with diabetes or smoking, obesity without diabetes or smoking, and hypertension. Compared with no comorbidities, risk of complications was higher in the smoking (OR 1.32, 95% CI 1.18-1.49), bleeding disorder or CHF (OR 1.68, 95% CI 1.23-2.29), obesity with diabetes or smoking (OR 1.41, 95% CI 1.25-1.58), obesity without diabetes or smoking (OR 1.17, 95% CI 1.06-1.29), and hypertension (OR 1.16, 95% CI 1.05-1.28) clusters. These clusters also had longer hospital stays compared to patients with no comorbidities. 30-day mortality was significantly increased in the "bleeding disorder or CHF" (OR 3.22, 95% CI 1.52-6.84) and hypertension (OR 1.66, 95% CI 1.09-2.54) clusters.
CONCLUSION: Distinct comorbidity clusters predict complications, prolonged hospitalization, and mortality following hernia repair. Incorporating comorbidity profiles into preoperative risk stratification may enhance surgical decision-making, allow targeted interventions, and improve outcomes in high-risk patients.
METHODS: We performed a retrospective cohort study using the ACS-NSQIP database (2016-2023). Adults undergoing elective inguinal or ventral hernia repair were identified using CPT and ICD-10 codes. Latent class analysis (LCA) identified subgroups of patients who shared similar patterns of comorbidities. Outcomes included postoperative complications, hospital length of stay, and 30-day mortality.
RESULTS: Among 224,522 patients, LCA identified six profiles: no comorbidities, smoking, bleeding disorder or congestive heart failure (CHF), obesity with diabetes or smoking, obesity without diabetes or smoking, and hypertension. Compared with no comorbidities, risk of complications was higher in the smoking (OR 1.32, 95% CI 1.18-1.49), bleeding disorder or CHF (OR 1.68, 95% CI 1.23-2.29), obesity with diabetes or smoking (OR 1.41, 95% CI 1.25-1.58), obesity without diabetes or smoking (OR 1.17, 95% CI 1.06-1.29), and hypertension (OR 1.16, 95% CI 1.05-1.28) clusters. These clusters also had longer hospital stays compared to patients with no comorbidities. 30-day mortality was significantly increased in the "bleeding disorder or CHF" (OR 3.22, 95% CI 1.52-6.84) and hypertension (OR 1.66, 95% CI 1.09-2.54) clusters.
CONCLUSION: Distinct comorbidity clusters predict complications, prolonged hospitalization, and mortality following hernia repair. Incorporating comorbidity profiles into preoperative risk stratification may enhance surgical decision-making, allow targeted interventions, and improve outcomes in high-risk patients.