Improved Understanding of Acute Incisional Hernia Incarceration: Implications for Addressing the Excess Mortality of Emergent Repair.

Abstract Background Up to 20% of patients undergoing abdominal surgery will develop an incisional hernia. We sought to identify characteristics associated with poor outcomes after acute incisional hernia incarceration. Study Design We performed a retrospective cohort study of adult patients with incisional hernias undergoing elective repair or with acute incarceration between 2010-2017. The primary outcome was 30-day mortality. Logistic regression was utilized to determine adjusted odds associated with 30-day mortality. The American College of Surgeons (ACS) risk calculator was utilized to estimate outcomes had these patients undergone elective repair. Results A total of 483 patients experienced acute incarceration; 30-day mortality was 9.52%. Increasing age (aOR 1.05, 95% CI 1.02-1.08) and bowel resection (aOR 3.18, 95% CI 1.45-6.95) were associated with mortality. Among those with acute incarceration, 231 (47.9%) had no documentation of a prior surgical evaluation while 252 (52.2%) had been evaluated but had not undergone elective repair. Among patients ≥80 years, 30-day mortality after emergent repair was high (22.9%) compared to estimated 30-day mortality for elective repair (0.73%) based on the ACS risk calculator. Estimated mortality was comparable to observed elective repair mortality (0.82%) in an age-matched cohort. Similar mortality trends were noted for patients Conclusion Comparison of predicted elective repair and observed emergent repair mortality in patients with acute incarceration suggests that acceptable outcomes could have been achieved with elective repair. Almost half of acute incarceration patients had no prior surgical evaluation, thus targeted interventions to address surgical referral may potentially result in fewer incarceration-related deaths.