Predictors of acute incisional hernia incarceration at initial hernia diagnosis on computed tomography.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
19 Jun 2023
19 Jun 2023
Historique:
medline:
19
6
2023
pubmed:
19
6
2023
entrez:
19
6
2023
Statut:
aheadofprint
Résumé
Acute incisional hernia incarceration is associated with high morbidity and mortality yet there is little evidence to guide which patients will benefit most from prophylactic repair. We explored baseline computed tomography (CT) characteristics associated with incarceration. A case-control study design was utilized to explore adults (≥18 years) diagnosed with an incisional hernia between 2010-2017 at a single institution with a 1-year minimum follow-up. CT imaging at the time of initial hernia diagnosis was examined. Following propensity score matching for baseline characteristics, multivariable logistic regression was performed to identify independent predictors associated with acute incarceration. A total of 532 patients (27.26% male, mean 61.55 years) were examined, of whom 238 experienced an acute incarceration. Between two well-matched cohorts with and without incarceration, the presence of small bowel in the hernia sac (OR 7.50, 95% CI 3.35-16.38), increasing sac height (OR 1.34, 95% CI 1.10-1.64), more acute hernia angle (OR 0.98 per degree, 95% CI 0.97-0.99), decreased fascial defect width (OR 0.68, 95% CI 0.58-0.81), and greater outer abdominal fat (OR 1.28, 95% CI 1.02-1.60) were associated with acute incarceration. Using threshold analysis, a hernia angle of <91 degrees and a sac height of >3.25 cm were associated with increased incarceration risk. CT features present at the time of hernia diagnosis provide insight into later acute incarceration risk. Improved understanding of acute incisional hernia incarceration can guide selection for prophylactic repair and thereby may mitigate the excess morbidity associated with incarceration. Level IVStudy Type: prognostic/epidemiological.
Sections du résumé
BACKGROUND
BACKGROUND
Acute incisional hernia incarceration is associated with high morbidity and mortality yet there is little evidence to guide which patients will benefit most from prophylactic repair. We explored baseline computed tomography (CT) characteristics associated with incarceration.
METHODS
METHODS
A case-control study design was utilized to explore adults (≥18 years) diagnosed with an incisional hernia between 2010-2017 at a single institution with a 1-year minimum follow-up. CT imaging at the time of initial hernia diagnosis was examined. Following propensity score matching for baseline characteristics, multivariable logistic regression was performed to identify independent predictors associated with acute incarceration.
RESULTS
RESULTS
A total of 532 patients (27.26% male, mean 61.55 years) were examined, of whom 238 experienced an acute incarceration. Between two well-matched cohorts with and without incarceration, the presence of small bowel in the hernia sac (OR 7.50, 95% CI 3.35-16.38), increasing sac height (OR 1.34, 95% CI 1.10-1.64), more acute hernia angle (OR 0.98 per degree, 95% CI 0.97-0.99), decreased fascial defect width (OR 0.68, 95% CI 0.58-0.81), and greater outer abdominal fat (OR 1.28, 95% CI 1.02-1.60) were associated with acute incarceration. Using threshold analysis, a hernia angle of <91 degrees and a sac height of >3.25 cm were associated with increased incarceration risk.
CONCLUSION
CONCLUSIONS
CT features present at the time of hernia diagnosis provide insight into later acute incarceration risk. Improved understanding of acute incisional hernia incarceration can guide selection for prophylactic repair and thereby may mitigate the excess morbidity associated with incarceration.
LEVEL OF EVIDENCE
METHODS
Level IVStudy Type: prognostic/epidemiological.
Identifiants
pubmed: 37335920
doi: 10.1097/TA.0000000000003994
pii: 01586154-990000000-00424
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and source of funding: Nothing to disclose. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.