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Risk Factors for Bad Outcomes in Incisional Hernia Repair: Lessons Learned From the National Registry of Incisional Hernia (EVEREG)
Factores de riesgo de mala evolución en la reparación de hernias incisionales: Lecciones aprendidas del Registro Nacional de Hernia Incisional (EVEREG)
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José Antonio Pereiraa,b,
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86664@parcdesalutmar.cat

Corresponding author.
, Blanca Montcusía, Manuel López-Canoc,d, Pilar Hernández-Granadose, Laura Fresno de Pradob, Members of the EVEREG Registry
a Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, Spain
b Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
c Servicio de Cirugía General, Hospital Vall d’Hebron, Barcelona, Spain
d Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain
e Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Received 27 October 2017. Accepted 24 March 2018
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Tables (6)
Table 1. Characteristics of the Cohort Patients.
Table 2. Comparison of Patient-Related Parameters and the Appearance of Postoperative Complications and Recurrences.
Table 3. Comparison of Hernia Characteristics With the Appearance of Postoperative Complications and Recurrences.
Table 4. Comparison of the Technical Circumstances and the Appearance of Postoperative Complications and Recurrences.
Table 5. Multivariate Analysis of Variables Associated With Postoperative Complications.
Table 6. Multivariate Analysis of Variables Associated With Recurrences.
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Abstract
Introduction

Registries are powerful tools for identifying factors predicting bad results. Our objective was to analyze data from the Spanish Registry of Incisional Hernia (EVEREG) to detect risk situations for the development of complications and recurrences.

Methods

We have analyzed data of the cohort of hernias registered during the period from July 2012 to June 2014. We have compared the data between complicated and non-complicated patients in the short and long term follow-up. Data compared were: patient demographics, comorbid condition, hernia defect characteristics and surgical technique to determine which of them may be predictors of poor outcomes.

Results

During the period of study, we collected data from 1336 hernias (43.7% males; 56.3% females) with a mean age of 63.6 years (SD 12.4) and BMI of 30.4 (SD 5.4). In the multivariate analysis, factors associated with complications were: age >70 years, previous neoplasm, diameter greater than 10cm, previous repair and bowel resection. Factors related with recurrences were: parastomal hernia, previous repair, emergency repair, postoperative complications and reoperation. A separation of components was the only protective factor for this type of analysis (OR 0.438; CI 0.27–0.71; P=.0001).

Conclusions

Risk factors for the development of complications and recurrences must be considered for promoting preoperative patient prehabilitation, planning the surgical technique and referring patients to specialized abdominal wall units.

Keywords:
Incisional hernia
Registries
Risk factors
Resumen
Introducción

Los registros son herramientas potentes para identificar situaciones de riesgo de mala evolución. Nuestro objetivo ha sido analizar los datos del Registro Nacional de Hernia Incisional (EVEREG) para detectar situaciones de riesgo para el desarrollo de complicaciones y recidivas.

Métodos

Se analizan los datos de la cohorte de hernias registradas en el período desde julio de 2012 hasta junio de 2014. Se realiza una comparación estadística entre las hernias que presentaron complicaciones y recidivas, y su relación con los pacientes, las características de las hernias y la técnica quirúrgica, para determinar cuáles de ellos pueden predecir malos resultados.

Resultados

En el período de estudio disponemos de datos de 1.336 hernias (43,7% varones; 56,3% mujeres), con una edad media de 63,6 años (DE: 12,4) e IMC de 30,4 (DE: 5,4). En el estudio multivariante las variables asociadas a la presencia de complicaciones fueron: edad superior a 70 años, neoplasia, longitud del defecto mayor de 10cm, reparación previa y resección intestinal. Las variables asociadas a recidiva fueron: las hernias paraestomales, la reparación previa, la cirugía urgente, la aparición de complicaciones postoperatorias y la reintervención quirúrgica. El uso de una separación de componentes fue el único factor protector en este tipo de análisis (OR: 0,438; IC: 0,27–0,71; p=0,001).

Conclusiones

La presencia de factores de riesgo para la aparición de complicaciones y recurrencias debe ser tenida en cuenta con el fin de proyectar la prehabilitación del paciente para la cirugía, planificar la técnica quirúrgica y su derivación a unidades especializadas.

Palabras clave:
Hernia incisional
Registros
Factores de riesgo

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