Hernia repair in the presence of ascites

• Published in: The Journal of surgical research 2014-08, Vol.190 (2), p.471-477
• Main Authors: Ecker, Brett L., MD, Bartlett, Edmund K., MD, Hoffman, Rebecca L., MD, Karakousis, Giorgos C., MD, Roses, Robert E., MD, Morris, Jon B., MD, Kelz, Rachel R., MD
• Format: Article
• Language: English
• Subjects: ACS NSQIP; Adult; Aged; Ascites; Ascites - complications; Cohort Studies; Female; Hernia repair; Hernia, Abdominal - etiology; Hernia, Abdominal - surgery; Herniorrhaphy - mortality; Humans; Male; MELD; Middle Aged; Morbidity; Mortality; Postoperative Complications - mortality; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2014.05.039

Abstract Background The model for end-stage liver disease (MELD) has been validated as a prediction tool for postoperative mortality, but its role in predicting morbidity has not been well studied. We sought to determine the role of MELD, among other factors, in predicting morbidity and mortality in patients with nonmalignant ascites undergoing hernia repair. Methods All patients undergoing hernia repair in the American College of Surgeons National Surgical Quality Improvement database (2009–11) were identified. Those with nonmalignant ascites were compared with patients without ascites. A subset analysis of patients with nonmalignant ascites was performed to evaluate the association between MELD and morbidity and mortality with adjustment for potential confounders. The association of significant factors with the rate of morbidity was displayed using a best-fit polynomial regression. Results Of 138,366 hernia repairs, 778 (0.56%) were performed on patients with nonmalignant ascites. Thirty-day morbidity (4% versus 19%) and mortality (0.2% versus 5.3%) were significantly more frequent in patients with ascites ( P  < 0.001). In univariate analysis of the 636 patients with a calculable MELD, MELD was associated with both morbidity and mortality ( P  < 0.001 each). In multivariate analysis, MELD remained significantly associated with morbidity (odds ratio [OR] = 1.11). Ventral hernia repair (OR = 2.9), dependent functional status (OR = 2.3), alcohol use (OR = 2.3), emergent operation (OR = 2.0) white blood count (OR = 1.1), and age (OR = 1.02) were also significantly associated with morbidity ( P  < 0.05). Conclusions Before hernia repair, the MELD score can be used to risk-stratify patients with nonmalignant ascites not only for mortality but also morbidity. Morbidity rates increase rapidly with MELD above 15, but other factors should additionally be accounted for when counseling patients on their perioperative risk.