Association of socioeconomic vulnerability with clinical and financial outcomes following emergent hernia repair.

BACKGROUND: While race and insurance have been linked with greater likelihood of hernia incarceration and emergent presentation, the association of broader social determinants of health (SDOH) with outcomes following urgent repair remains to be elucidated. STUDY DESIGN: All adult hospitalizations entailing emergent repair for strangulated inguinal, femoral, and ventral hernias were identified in the 2016-2020 Nationwide Readmissions Database. Socioeconomic vulnerability was ascertained using relevant diagnosis codes. Multivariable models were developed to consider the independent associations between socioeconomic vulnerability and study outcomes. RESULTS: Of ∼236,215 patients, 20,306 (8.6 â€‹%) were Vulnerable. Following risk-adjustment, socioeconomic vulnerability remained associated with greater odds of in-hospital mortality, any perioperative complication, increased hospitalization expenditures and higher risk of non-elective readmission. CONCLUSIONS: Among patients undergoing emergent hernia repair, socioeconomic vulnerability was linked with greater morbidity, expenditures, and readmission. As part of patient-centered care, novel screening, postoperative management, and SDOH-informed discharge planning programs are needed to mitigate disparities in outcomes.

Is surgical repair of an asymptomatic groin hernia appropriate? A review.

PURPOSE: Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias. METHODS: The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library. RESULTS: The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no difference in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-effectiveness of elective repair compared to watchful waiting. CONCLUSION: Watchful waiting for asymptomatic groin hernias is a safe and cost-effective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months.

[Repairs of inguinofemoral and ventral hernias--review]. / A lágyéktáji és hasfali sérvek laparoscopos mutétei - áttekintés.

In this article the author reviews the results, technology and latest achievements in the history of laparoscopic hernia repair. In conclusion, having considered the advantages and disadvantages, laparoscopic hernia repair offers the best results in terms of early rehabilitation, early and long-term postoperative pain and a very low recurrence rate (less than 1% and 5%). In the hands of experienced laparoscopic surgeons, it remains the gold standard for hernia repairs indisputably.

Groin hernias in patients 50 years of age and above pattern and outcome of management in 250 consecutive patients.

A prospective survey of 250 elderly patients was carried out over a period of 5 years (1992-1996) to determine the pattern, outcome and prognostic factors of inguinal hernia repair in this groups of patients. The result showed that the mean age to be 61.5 years with male patients of 90%. Hernia was commonest on the right side in 49.6%, and bilateral in 15.2%. They were inguinal hernia and inguinoscrotal hernia in 63.2% and 31.2% and 31.2% respectively and femoral hernia in 5.6%. In 51.2% of the patients there were associated diseases. In 24.8% lower obstructive uropathy was diagnosed, of 5.6% presented in acute urinary retention and 3 cases of carcinoma of the prostate. Cardiopulmonary diseases in 19.6%. The hernia was incarcerated in 22.4%. More than half (55%) were operated under local or regional anaesthesia. In 22.4%, additional operative procedures were carried out, of which 62.6% of such patients had prostatectomy. They mean hospital stay was 4 days, 60% were operated as day surgery. Postoperative complications of scrotal haematoma/oedema in 16.4%, wound infections of 14.4%, postoperative hernia recurrence of 2.8% and death occurred in 1.6% of the patients. The outcome were significantly affected by the age, associated diseases, hernia complications such as incarceration or strangulation and the need for additional surgical procedures.

[Experience with the laparoscopic repair of inguinofemoral hernias]. / Inguinofemoralis sérvek laparoszkópos megoldásával szerzett tapasztalataink.

The authors have performed 110 inguinofemoral hernioplasties on 100 patients by transabdominal endoscopic method. There has been only one serious complication: a 50 years old man was reoperated on against a trocar-site bleeding and a postoperative adhesion-ileus. All patients recovered. The authors have got good experiences: postoperative pains are minimal, hospitality is short, ability to work comes back soon. Technics of the operation and cost-analysis are discussed here.

[Organizational and surgical-technical aspects of the service of abdominal hernioplasty]. / Aspetti organizzativi e tecnico-chirurgici di un servizio di chirurgia delle ernie addominali.

The authors guided by the experience matured from 1/01/94 to 30/06/97 (435 abdominal hernioplasties performed, mainly inguinal and femoral) illustrate the organizational formalities and the technical aspects of a Hernia Surgery Service. In particular, they highlight the advantages of the routine use of local anaesthesia and of tension-free techniques, carried out on a day surgery rule (immediate rehabilitation, greater facilitation to elective surgery, access to the elderly at high anaesthetic risk). Eventually, they emphasize the remarkable reduction of sanitary costs and the outstanding social, practical and didactic value of such Hernia Centers.