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Risk Factors for Mortality in Patients with Ventral Hernia Admitted Emergently: An Analysis of 48,539 Adult Patients.

BACKGROUND
More than 400,000 cases of ventral hernia (VH) are repaired each year in the U.S. This condition is a major problem with significant morbidly and mortality. The aim of this study was to evaluate independent predictors of in-hospital mortality for patients with a primary diagnosis of VH who were admitted emergently.


METHODS
Non-elderly adults (age 18-64 years) with ventral hernias that required emergency admission were analyzed using the National Inpatient Sample database, 2005-2014. Demographics, clinical data, and outcomes were collected. The relationships between mortality and predictors were assessed using a multivariable logistic regression model.


RESULTS
Overall, 48,539 patients were identified. The mean (SD) age for both males and females was 50 (9.6). Overall mortality was low (316 or 0.7%). Males accounted for 35% of the total sample and 45% of all mortalities (p <0.001). The mean (SD) hospital length of stay (HLOS) was 4.9 (6.3) and 12.3 (20.6) days in surviving and deceased patients (p <0.001), respectively. Approximately 1.1% of surviving and 6% of deceased patients had gangrene (p <0.001). Intestinal obstruction was observed in 70% of surviving and 83% of deceased patients (p <0.001). While a vast majority of the patients (40,602) were operated on, 8,023 patients were not; 0.7% and 0.4% died, respectively. The mean (SD) HLOS was 5.30 (6.99) days in patients who underwent an operation and 2.97 (2.96) days in those who did not (P <0.0001). Time to operation was 0.81 (1.92) days in surviving and 1.34 (2.42) days in deceased patients (p <0.001). In the final multivariable regression model for patients who underwent an operation, age, male sex, presence of gangrene or obstruction, and longer time to operation were the main risk factors for mortality. For patients who did not undergo an operation, only HLOS and presence of obstruction were the main risk factors for mortality.


CONCLUSION
Male sex, presence of gangrene or obstruction at the presentation, and delayed operation were shown to be risk factors for mortality in adult patients with ventral hernia admitted emergently.