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Paracolostomy hernia repair: who and when?
Zachary A Gregg1, Haisar E Dao1, Steven Schechter1
1Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
Journal of the American College of Surgeons
|April 8, 2014
Summary
Emergency paracolostomy hernia repair (PHR) significantly increases complication and mortality risks, particularly in patients over 70. Elective PHR is a safer option, especially for the elderly, warranting greater consideration for planned procedures.
Area of Science:
- Colorectal Surgery
- Abdominal Wall Reconstruction
- Surgical Outcomes Research
Background:
- Paracolostomy hernia repair (PHR) presents significant challenges with high morbidity and recurrence rates.
- Analyzing complication rates and 30-day mortality is crucial for optimizing PHR patient outcomes.
Purpose of the Study:
- To analyze the complication rate and 30-day mortality associated with paracolostomy hernia repair (PHR).
- To compare outcomes between emergent and non-emergent PHR, and in patients stratified by age (>70 years).
Main Methods:
- Retrospective analysis of 519 patients undergoing PHR using the NSQIP database (2005-2008).
- Utilized Current Procedural Terminology code 44346 for patient identification.
- Performed univariate analysis of 30-day outcomes for emergent vs. non-emergent repairs and age groups.
Main Results:
- Emergency PHR (11.4% of cases) was linked to significantly higher rates of organ space surgical site infection (SSI), pneumonia, septic shock, total morbidity, and death.
- These adverse outcomes were amplified in patients over 70 undergoing emergency PHR.
- Elective PHR demonstrated relatively safe outcomes, even in the elderly population.
Conclusions:
- Most paracolostomy hernia repairs (PHRs) are performed electively.
- Emergency PHR is associated with substantially increased morbidity and mortality, especially pulmonary and septic complications.
- Elective repair should be prioritized for elderly patients to mitigate risks associated with emergency paracolostomy hernia repair.
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