Article

Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone.

Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
Surgical Endoscopy (Impact Factor: 3.43). 06/2012; DOI: 10.1007/s00464-012-2408-z
Source: PubMed

ABSTRACT BACKGROUND: Although incidental hernias frequently are found and repaired during laparoscopic cholecystectomy (LC), the outcomes of simultaneous LC and laparoscopic ventral hernia repair (LVHR) have not been scrutinized. In this study we evaluated short-term outcome data comparing simultaneous LC and LVHR against LC alone. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2009) was queried using primary procedure and secondary current procedural terminology (CPT(®)) codes for LC and LVHR. Outcomes analyzed included separate LC and LVHR and simultaneous laparoscopic cholecystectomy and ventral hernia repair (LC/LVHR). The 30 day clinical outcomes along with postoperative hospital length of stay (LOS) were assessed using the χ(2) test and analysis-of-variance test with p values < 0.01 set as significant. We also performed forward stepwise multivariable regression taking in to consideration over 50 ACS NSQIP risk factors to adjust for patient risk. RESULTS: A total of 82,837 patients underwent LC and/or LVHR of which 357 (0.4 %) underwent simultaneous LC/LVHR. Patients who underwent LC/LVHR were more likely to have surgical site infections, suffer sepsis or septic shock, and have pulmonary complications, including pneumonia, reintubation or prolonged ventilator requirements, than LC-alone patients. No difference was noted in 30 day mortality, rates of deep vein thrombosis/pulmonary embolism (DVT/PE), renal insufficiency, or stroke. After multivariable adjustment for over 50 ACS NSQIP risk factors, concurrent LC/LVHR continued to pose a higher risk for these outcomes relative to LC only. CONCLUSIONS: Simultaneous LC/LVHR results in greater postoperative morbidity in terms of surgical site infections, sepsis, and pulmonary complications when compared to LC alone. In light of this increased short-term morbidity, consideration should be given toward performing LC and LVHR independently in patients requiring both procedures. Prospective studies with long-term follow-up are required to better understand the implications of simultaneous LC/LVHR.

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    ABSTRACT: Background Ventral hernia repair (VHR), an increasingly common procedure, may have a larger impact on healthcare costs than is currently appreciated. Readmissions have the potential to further increase these costs and negatively impact patient outcomes. New national registry data allows for an in-depth look at the predictors and rates of readmission after VHR. Methods The American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients who underwent only an incisional or ventral hernia repair in 2011. Patients who had any concomitant procedure were excluded from the study. Using readmission as the dependent variable, a multivariate logistic regression model was created to identify independent predictors of readmission. Results Ventral hernia repair had a 4.9% thirty-day readmission rate in 2011. Deep/incisional (12.6%) and superficial site infections (10.5%) were the most common wound complications seen in readmitted patients (both p<0.001), while sepsis/septic shock (10.14%, p<0.001) was the most common systemic complication. Higher-class body mass index is not associated with readmission (p=0.320). Smoking and chronic obstructive pulmonary disease function as predictors of readmission independently from their association with complications (OR 1.3, 95% CI 1.1-1.6; OR 1.6, 95% CI 1.1-2.3, respectively). Operative factors such as the use of mesh (OR 1.3, 95% CI 0.995-1.7) or laparoscopy (OR 1.2, 95% CI 0.96-1.6) do not increase likelihood of readmission. Conclusions There is room for improvement in VHR readmission rates. Though complications are the main driver of readmission, surgeons must be aware of the comorbidities that independently increase odds of readmission even when a complication does not occur.
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