Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P013: GROIN HERNIA REPAIR IN VETERANS
Matthew Georgis, MD1; Awni D Shahait, MD1; William Tracy1; Kara Girten, MSN, RN, CNOR2; Khaled J Saleh, MD, MPH, FRCSC, MHCM, CPE2; Donald Weaver, MD1; Scott A Gruber, MD, PhD, MBA, FACS, FCP, FACHE, CPE2; Gamal Mostafa, MD1; 1Wayne State University / Detroit Medical Center; 2John D Dingell VA Medical Center
Objective: The outcomes of groin hernia repair achieved via differing operative techniques continues to be of interest. It is commonly perceived that most repairs are performed laparoscopically, with presumed better outcomes when compared with the open approach. This study compares the recent profile and outcomes of groin hernia repair performed via the open and laparoscopic approaches in the veteran population.
Methods: The Veteran Affairs Surgical Quality Improvement Program was queried for all inguinal and femoral hernia repairs performed between 2008 and 2015. Data collection included patient demographics, operative details, and postoperative outcomes. Univariate and multivariate regression analyses were used, and a p value of ≤ 0.05 was considered significant.
Results: A total of 3,276 patients were identified (99.6% male, mean age 61 ±11 years, mean BMI 27.5 ±4.5, and 97.0% with ASA class ≥III). Mean operative time (OT) was 1.7 ±0.8 hr, and only 1.5% were emergency procedures. In this overall cohort, there were 11 (0.3%) mortalities, complications occurred in 81 (2.5%) patients [superficial surgical site infection (SSI) 0.7%, deep SSI 0.1%, and reoperation rate 1.2%], and mean postoperative length of stay (LOS) was 2.8 ±5.2 days. Repair was performed openly in 79.1% and laparoscopically in 20.9% of patients. When compared with open repair, patients undergoing laparoscopic repair were younger (59.8 vs. 61.5 years, p=0.001),and more likely to be functionally independent (99.9% vs. 98.7%, p=0.005), have ASA class ≥III (98.8% vs. 96.5%, p=0.001), have lower BMI (27.1 vs. 27.6, p=0.042), undergo bilateral repair (45% vs. 9%, p<0.001), and have longer OT (1.86 vs. 1.69 hr, p<0.001). Patients having laparoscopic repair were less likely to undergo emergency surgery (0.4% vs. 1.8%, p=0.007) and be admitted (5.2% vs. 11.0%, p=0.007), and had shorter LOS (1.8 vs. 3.0 days, p<0.001). Morbidity and mortality were not significantly different between the two groups (p=0.33 and 0.47, respectively). Functionally dependent status was an independent predictor of complications (OR 5.0, p=0.008) while emergent procedure was a predictor of 30-day mortality (OR 5.5, p=0.03).
Conclusion: The majority of groin hernias are still repaired using the open technique in veterans. Laparoscopic repairs are more commonly bilateral with slightly longer operative time and faster recovery when compared with open operations, but morbidity and mortality were similar via both approaches. Functional status and emergency surgery are independent predictors of poor outcomes.
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