Microbiological etiology and current resistance patterns in acute calculous cholecystitis.

INTRODUCTION: The current treatment for acute calculous cholecystitis (ACC) is early laparoscopic cholecystectomy, in association with appropriate empiric antibiotic therapy. In our country, the evolution of the prevalence of the germs involved and their resistance patterns have been scarcely described. The aim of the study was to analyze the bacterial etiology and the antibiotic resistance patterns in ACC. METHODS: We conducted a single-center, retrospective, observational study of consecutive patients diagnosed with ACC between 01/2012 and 09/2019. Patients with a concomitant diagnosis of pancreatitis, cholangitis, postoperative cholecystitis, histology of chronic cholecystitis or carcinoma were excluded. Demographic, clinical, therapeutic and microbiological variables were collected, including preoperative blood cultures, bile and peritoneal fluid cultures. RESULTS: A total of 1104 ACC were identified, and samples were taken from 830 patients: bile in 89%, peritoneal fluid and/or blood cultures in 25%. Half of the bile cultures and less than one-third of the blood and/or peritoneum samples were positive. Escherichia coli (36%), Enterococcus spp (25%), Klebsiella spp (21%), Streptococcus spp (17%), Enterobacter spp (14%) and Citrobacter spp (7%) were isolated. Anaerobes were identified in 7% of patients and Candida spp in 1%. Nearly 37% of patients received inadequate empirical antibiotic therapy. Resistance patterns were scrutinized for each bacterial species. The main causes of inappropriateness were extended-spectrum beta-lactamase-producing bacteria (34%) and Enterococcus spp (45%), especially in patients older than 80 years. CONCLUSIONS: Updated knowledge of microbiology and resistance patterns in our setting is essential to readjust empirical antibiotic therapy and ACC treatment protocols.

Impact of empiric antibiotic therapy on the clinical outcome of acute calculous cholecystitis.

PURPOSE: Although mortality and morbidity of severe acute calculous cholecystitis (ACC) are still a matter of concern, the impact of inadequate empirical antibiotic therapy has been poorly studied as a risk factor. The objective was to assess the impact of the adequacy of empirical antibiotic therapy on complication and mortality rates in ACC. METHODS: This observational retrospective cohort chart-based single-center study was conducted between 2012 and 2016. A total of 963 consecutive patients were included, and pure ACC was selected. General, clinical, postoperative, and microbiological variables were collected, and risk factors and consequences of inadequate treatment were analyzed. RESULTS: Bile, blood, and/or exudate cultures were obtained in 76.3% of patients, more often in old, male, and severely ill patients (P < 0.001). Patients who were cultured had a higher overall rate of postoperative complications (47.4% vs. 29.7%; P < 0.001), as well as of severe complications (11.6% vs. 4.7%; P = 0.008). Patients with positive cultures had more overall complications (54.8% vs. 39.6%; P = 0.001), more severe complications (16.3% vs. 6.7%; P = 0.001), and higher mortality rates (6% vs. 1.9%; P = 0.012). Patients who received inadequate empirical antibiotic therapy had a fourfold higher mortality rate than those receiving adequate therapy (n = 283; 12.8% vs. 3.4%; P = 0.003). This association was especially marked in severe ACC TG-III patients (n = 132; 18.2 vs. 5.1%; P = 0.018) and remained a predictor of mortality in a binary logistic regression (OR 4.4; 95% CI 1.3-15.3). CONCLUSION: Patients with positive cultures developed more complications and faced higher mortality. Adequate empirical antibiotic therapy appears to be of paramount importance in ACC, particularly in severely ill patients.

Análisis de los factores de riesgo para complicaciones en la colecistitis aguda litiásica. Deconstrucción de las Tokyo Guidelines / Risk factors for complications in acute calculous cholecystitis. Deconstruction of the Tokyo Guidelines

Introducción: Analizar los factores de riesgo de complicaciones para colecistitis aguda litiásica confrontándolos a las Tokyo Guidelines. Métodos: Estudio retrospectivo de 963 pacientes con colecistitis aguda durante 5 años. Se seleccionaron 725 pacientes con colecistitis aguda litiásica «pura», y analizaron 166 variables mediante regresión logística, incluyendo todos los factores de riesgo de las Tokyo Guidelines. Mediante el Propensity Score Matching, se seleccionaron subpoblaciones comparables de 75 pacientes y se analizaron las complicaciones según el tratamiento realizado (quirúrgico/no quirúrgico) y se utilizó el fallo en el rescate como indicador de calidad del tratamiento en la colecistitis aguda litiásica. Resultados: La mediana de edad fue de 69 años (RIQ 53-80). La mayoría de los pacientes fueron ASA II o III (85,1%). El 21% de las colecistitis fueron leves, el 39% moderadas y el 40% graves. Se colecistectomizó al 95% de los pacientes. El 43% de los pacientes se complicaron y la mortalidad fue del 3,6%. Los factores de riesgo independientes para complicaciones graves fueron ASA>II, tumor sólido sin metástasis e insuficiencia renal. El fallo en el rescate (8%) fue mayor en los no operados (32% vs. 7%; P=0,002). Tras realizar el Propensity Score Matching, la tasa de complicaciones graves fueron comparables entre operados y no operados (48,5% vs. 62,5%; P=0,21). Conclusiones: La colecistectomía precoz es el tratamiento preferente para la colecistitis aguda litiásica. Solo tres de los factores de las Tokyo Guidelines son variables independientes para predecir complicaciones graves. El fallo en el rescate es mayor en los pacientes no intervenidos quirúrgicamente. (AU)

Introduction: To challenge the risk factors described in Tokyo Guidelines in acute calculous cholecystitis. Methods: Retrospective single center cohort study with 963 patients with acute cholecystitis during a period of 5 years. Some 725 patients with a “pure” Acute calculous cholecystitis were selected. The analysis included 166 variables encompassing all risk factors described in Tokyo Guidelines. The Propensity Score Matching method selected two subgroups of patients with equal comorbidities, to compare the severe complications rate according to the initial treatment (Surgical vs. non-surgical). We analyzed the failure-to-rescue as a quality indicator in the treatment of acute calculous cholecystitis. Results: The median age was 69 years (IQR 53-80). 85.1% of the patients were ASA II or III. The grade of the acute calculous cholecystitis was mild in a 21%, moderate in 39% and severe in 40% of the patients. Cholecystectomy was performed in 95% of the patients. The overall complications rate was 43% and the mortality was 3.6%. The Logistic Regression model isolated 3 risk factor for severe complication: ASA>II, cancer without metastases and moderate to severe renal disease. The failure-to-rescue (8%) was higher in patients with non-surgical treatment (32% vs. 7%; P=.002). After Propensity Score Matching, the number of severe complications was similar between Surgical and Non-Surgical treatment groups (48.5% vs 62.5%; P=.21). Conclusions: The recommended treatment for acute calculous cholecystitis is the laparoscopic cholecystectomy. Only three risk factors from the Tokyo Guidelines list appeared as independent predictors of severe complications. The failure-to-rescue is higher in non-surgically treated patients. (AU)

Risk factors for complications in acute calculous cholecystitis. Deconstruction of the Tokyo Guidelines.

OBJECTIVE: To challenge the risk factors described in Tokyo Guidelines in Acute Calculous Cholecystitis. METHODS: Retrospective single center cohort study with 963 patients with Acute Cholecystitis during a period of 5 years. Some 725 patients with a "pure" Acute Calculous Cholecystitis were selected. The analysis included 166 variables encompassing all risk factors described in Tokyo Guidelines. The Propensity Score Matching method selected two subgroups of patients with equal comorbidities, to compare the severe complications rate according to the initial treatment (Surgical vs Non-Surgical). We analyzed the Failure-to-rescue as a quality indicator in the treatment of Acute Calculous Cholecystitis. RESULTS: the median age was 69 years (IQR 53-80). 85.1% of the patients were ASA II or III. The grade of the Acute Calculous Cholecystitis was mild in a 21%, moderate in 39% and severe in 40% of the patients. Cholecystectomy was performed in 95% of the patients. The overall complications rate was 43% and the mortality was 3.6%. The Logistic Regression model isolated 3 risk factor for severe complication: ASA > II, cancer without metastases and moderate to severe renal disease. The Failure-to-Rescue (8%) was higher in patients with non-surgical treatment (32% vs. 7%; P = 0.002). After Propensity Score Matching, the number of severe complications was similar between Surgical and Non-Surgical treatment groups (48.5% vs 62.5%; P = 0.21). CONCLUSIONS: the recommended treatment for Acute Calculous Cholecystitis is the Laparoscopic Cholecystectomy. Only three risk factors from the Tokyo Guidelines list appeared as independent predictors of severe complications. The failure-to-rescue is higher in non-surgically treated patients.

Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines.

BACKGROUND: Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. METHODS: Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. RESULTS: The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7-12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34-12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02-1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5-28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). CONCLUSIONS: Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. TRIAL REGISTRATION: Retrospectively registered and recorded in Clinical Trials. NCT04744441.

Hernias de la incisión de asistencia tras resección colorrectal laparoscópica. Influencia de la localización de la incisión y del uso de una malla profiláctica / Hernias at the extraction incision after laparoscopic colon and rectal resection: Influence of incision location and use of prophylactic mesh

Objetivos: Determinar la incidencia de hernia incisional (HI) en la incisión de asistencia (IA) de la pieza en cirugía por neoplasia de colon y recto. Análisis de la relación de la localización de la incisión y uso de una malla en la prevención de la HI en pacientes de alto riesgo. Métodos: Revisión retrospectiva de la base de datos de cirugía de colon entre enero de 2015 y diciembre de 2016. Se establecieron 2 grupos: incisión transversa (IT) e incisión media (IM), a su vez este con 2 subgrupos (malla [IMM] y sutura [IMS]). Se categorizaron los pacientes mediante el sistema HERNIAscore. Las hernias se diagnosticaron clínicamente y por TAC. Resultados: Se intervino a 210 pacientes, de los que fueron incluidos 182. Tras un seguimiento de 13,0 meses, se detectaron un total de 39 HI (21,9%), de las que 23 (13,4%) fueron en las IA. Estas fueron mucho menos frecuentes en el grupo de IT (3,4%) y en el de IMM (5,9%) que en el de IMS (29,5%; p = 0,007). La probabilidad de aparición en el grupo IMS de una HI presentó una OR = 11,7 (IC 95%: 3,3-42,0) frente a las IT y de 4,3 (IC 95%: 1,1-16,3) frente al grupo IMM. Conclusiones: La localización de la incisión es relevante para disminuir las HI. La IT debería ser utilizada preferentemente. En los casos en que se utilice una IM, el uso de una malla profiláctica en pacientes de alto riesgo puede considerarse, ya que es seguro y con baja morbilidad

Objectives: To determine the incidence of incisional hernia (IH) in the extraction incision (EI) in colorectal resection for cancer. To analyze whether the location of the incision has any relationship with the incidence of hernias and whether mesh could be useful for prevention in high-risk patients. Methods: Retrospective review of the colon and rectal surgery database from January 2015 to December 2016. Data were classified into 2groups, transverse (TI) and midline incision (MI), and the latter was divided into 2subgroups (mesh [MIM] and suture [MIS]). Patients were classified using the HERNIA score. Hernias were diagnosed by clinical and/or CT examination. Results: A total of 182 out of 210 surgical patients were included. After a median follow-up of 13.0 months, 39 IH (21.9%) were detected, 23 of which (13.4%) were in the EI; their frequency was lower in the TI group (3.4%) and in the MIM group (5.9%) than in the MIS group (29.5%; p=0.007). The probability of developing IH in the MIS group showed an OR=11.7 (95%CI: 3.3-42.0) compared to the TI group and 4.3 (IC 95%: 1.1-16.3) versus the MIM group. Conclusions: The location of the incision is relevant to avoid incisional hernias. Transverse incisions should be used as the first option. When a midline incision is needed, a prophylactic mesh could be considered in high risk patients because it is safe and associated with low morbidity

Hernias at the extraction incision after laparoscopic colon and rectal resection: Influence of incision location and use of prophylactic mesh. / Hernias de la incisión de asistencia tras resección colorrectal laparoscópica. Influencia de la localización de la incisión y del uso de una malla profiláctica.

OBJECTIVES: To determine the incidence of incisional hernia (IH) in the extraction incision (EI) in colorectal resection for cancer. To analyze whether the location of the incision has any relationship with the incidence of hernias and whether mesh could be useful for prevention in high-risk patients. METHODS: Retrospective review of the colon and rectal surgery database from January 2015 to December 2016. Data were classified into 2groups, transverse (TI) and midline incision (MI), and the latter was divided into 2subgroups (mesh [MIM] and suture [MIS]). Patients were classified using the HERNIAscore. Hernias were diagnosed by clinical and/or CT examination. RESULTS: A total of 182 out of 210 surgical patients were included. After a median follow-up of 13.0 months, 39 IH (21.9%) were detected, 23 of which (13.4%) were in the EI; their frequency was lower in the TI group (3.4%) and in the MIM group (5.9%) than in the MIS group (29.5%; p=0.007). The probability of developing IH in the MIS group showed an OR=11.7 (95%CI: 3.3-42.0) compared to the TI group and 4.3 (IC 95%: 1.1-16.3) versus the MIM group. CONCLUSIONS: The location of the incision is relevant to avoid incisional hernias. Transverse incisions should be used as the first option. When a midline incision is needed, a prophylactic mesh could be considered in high risk patients because it is safe and associated with low morbidity.

Tuberculosis intestinal / Intestinal tuberculosis

No disponible

Terapia de presión negativa intermitente con instilación antibiótica en una fascitis necrosante de pared abdominal y retroperitoneal secundaria a hematoma renal derecho sobreinfectado / Intermitent negative-pressure therapy with antibiotic instillation for necrotizing fasciitis of the abdomen and retroperitoneum due to an infected renal hematoma

No disponible

Estudio del valor predictivo de la revisión primaria y de las exploraciones complementarias para anticipar la necesidad de intervención quirúrgica en pacientes con heridas de arma blanca en el torso / A study of the predictive value of the primary review and complementary examinations in assessing the need for surgery in patients with stab wounds in the torso

Introducción La observación es el patrón oro del tratamiento de heridas de arma blanca en pacientes estables. El objetivo del estudio fue analizar el valor de la exploración física inicial y de las exploraciones complementarias ante la necesidad de cirugía, para disminuir tiempos de observación. Material y métodos Estudio retrospectivo de un registro prospectivo de pacientes politraumáticos, seleccionando heridas de arma blanca troncales. Se analizan parámetros clínicos y diagnósticos. La variable principal es la necesidad de cirugía. Resultados Entre 2006 y 2009 se incluyó a 198 pacientes, con injury severity score medio de 7,8 ± 7 y mortalidad del 0,5%. El 52% sufrieron heridas múltiples que se distribuyeron en cervicales 23%, torácicas 46% y abdominales 31%. Precisaron intervención quirúrgica 73 pacientes (37%), siendo el 59% inmediata, 27% precoz y 14% tardía. La necesidad de intervención se asoció a un menor revised trauma score, evisceración, hemorragia activa o constatación de herida penetrante. Las hemoglobinas iniciales, a las 2 y 12 h fueron significativamente inferiores en pacientes quirúrgicos. La tomografía computarizada (TC) positiva se asoció a intervención. Un 18% de pacientes presentaron complicaciones, concentradas en los pacientes quirúrgicos. Las intervenciones tardías no presentaron más complicaciones que las inmediatas (p = 0,72). El 10% de los pacientes con exploración física y complementarias normales precisaron cirugía y el 6% desarrollaron complicaciones. Conclusión Ningún parámetro fisiológico o analítico guía de forma individual la necesidad de intervención. La exploración física seriada es la maniobra diagnóstica más importante para decidir intervención, pero la TC puede usarse de forma liberal. Una observación de 24 h es recomendable en pacientes con heridas penetrantes (AU)

Introduction Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. Methods A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. Results A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8 ± 7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. Conclusion None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds (AU)

[A study of the predictive value of the primary review and complementary examinations in assessing the need for surgery in patients with stab wounds in the torso]. / Estudio del valor predictivo de la revisión primaria y de las exploraciones complementarias para anticipar la necesidad de intervención quirúrgica en pacientes con heridas de arma blanca en el torso.

INTRODUCTION: Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. METHODS: A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. RESULTS: A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. CONCLUSION: None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds.

Hernia estrangulada. ¿Todavía mortal en el siglo XXI? / Strangulated hernia. Still fatal in the XXI century?

Introducción. El conocimiento de los factores que predisponen a la aparición de complicaciones tras cirugía herniaria urgente es de gran importancia tanto para la priorización de la cirugía electiva como para seleccionar los casos que pueden ser susceptibles de seguimiento clínico. Objetivos. Analizar los factores que condicionan la morbilidad y la mortalidad de la resección intestinal asociada a la reparación herniaria urgente. Pacientes y método. Revisión retrospectiva de las historias clínicas de los pacientes intervenidos urgentemente por afección herniaria desde enero de 2000 hasta diciembre de 2005. Se compararon los resultados obtenidos en función de si fue o no necesaria una resección intestinal. Resultados. De un total de 2.367 pacientes intervenidos por hernias en ese período, en 362 (15,3%; media de edad, 69,5 años; 146 varones y 216 mujeres) fue de forma urgente. Precisaron resección intestinal 60 (16,6%). Presentaron complicaciones 108 (29,8%) y 17 (4,7%) fallecieron tras la intervención. El límite de 70 años discriminó una mortalidad significativamente mayor (el 7 frente al 2%, entre mayores y menores de 70 años, respectivamente; p = 0,01). El grupo de pacientes que precisó resección intestinal tenía una media de edad mayor (75,4 frente a 68,3 años; p = 0,002), más prevalencia de complicaciones totales (el 40,7 frente al 6,2%; p < 0,0001) y una mortalidad significativamente mayor (el 20 frente al 1,6%; p < 0,0001). El análisis de discriminación identificó la resección intestinal como variable independiente predictiva de mortalidad (l de Wilks = 0,89; p = 0,0001; valor predictivo del 85%). Conclusiones. La morbilidad y la mortalidad de la cirugía herniaria urgente que precisa resección intestinal son muy elevadas, especialmente en pacientes de edad avanzada y cuando se trata de hernias crurales (AU)

Introduction. Knowledge of the risk factors that may lead to complications after emergency hernia repair is of great importance, as much for the prioritisation of the elective surgery, as selecting those cases that require clinical follow up. Objectives. To analyse the factors conditioning the morbidity and mortality of bowel resection associated to emergency hernia repair. Patients and method. A retrospective review was carried out on the clinical histories of patients who had emergency operations for hernia problems from January 2000 to December of 2005. The clinical results obtained were compared based on whether or not a bowel resection was required. Results. A total of 2367 patients were operated for hernia in this period, 362 of them (15.3%); for a complicated hernia (mean age 69.5 years; 146 males/216 females); 60 patients needed bowel resection. Complications appeared in 108 patients (29.8%) and 17 (4.7%) died after operation. The limit of 70 years discriminated a significantly greater mortality (> 70: 7% vs < 70 2%; p = 0.01).The group of patients who needed bowel resection showed differences in statistical analysis both in age (75.4 vs 68.3 years; p = 0.002), prevalence of complications (40.7% vs 6.2%; p < 0.0001), and mortality (20% vs 1.6%; p < 0.0001). The discriminant analysis identified bowel resection as the only predictive independent variable of mortality (l Wilks = 0.89; p = 0.0001; predictive value, 85%). Conclusions. Morbidity and the mortality of urgent hernia surgery, when bowel resection was required, are elevated; especially in older patients, and in crural hernias (AU)

[Strangulated hernia. Still fatal in the XXI century?]. / Hernia estrangulada. Todavía mortal en el siglo XXI?

INTRODUCTION: Knowledge of the risk factors that may lead to complications after emergency hernia repair is of great importance, as much for the prioritisation of the elective surgery, as selecting those cases that require clinical follow up. OBJECTIVES: To analyse the factors conditioning the morbidity and mortality of bowel resection associated to emergency hernia repair. PATIENTS AND METHOD: A retrospective review was carried out on the clinical histories of patients who had emergency operations for hernia problems from January 2000 to December of 2005. The clinical results obtained were compared based on whether or not a bowel resection was required. RESULTS: A total of 2367 patients were operated for hernia in this period, 362 of them (15.3%); for a complicated hernia (mean age 69.5 years; 146 males/216 females); 60 patients needed bowel resection. Complications appeared in 108 patients (29.8%) and 17 (4.7%) died after operation. The limit of 70 years discriminated a significantly greater mortality (> 70: 7% vs < 70 2%; p = 0.01). The group of patients who needed bowel resection showed differences in statistical analysis both in age (75.4 vs 68.3 years; p = 0.002), prevalence of complications (40.7% vs 6.2%; p < 0.0001), and mortality (20% vs 1.6%; p < 0.0001). The discriminant analysis identified bowel resection as the only predictive independent variable of mortality (lambda Wilks = 0.89; p = 0.0001; predictive value, 85%). CONCLUSIONS: Morbidity and the mortality of urgent hernia surgery, when bowel resection was required, are elevated; especially in older patients, and in crural hernias.