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Incisional hernia repair after caesarean section: a population-based study.
Antonia W Shand1, Jian Sheng Chen, Margaret Schnitzler
1Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia; Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia.
The Australian & New Zealand Journal of Obstetrics & Gynaecology
|December 3, 2014
Summary
Caesarean sections (CS) are associated with an increased risk of incisional hernia repair, with risk escalating with each additional CS. However, the overall incidence of incisional hernia repair remains low.
Area of Science:
- Obstetrics and Gynecology
- General Surgery
- Epidemiology
Background:
- Incisional hernias are a known complication at surgical abdominal incision sites.
- The specific association between caesarean sections (CS) and incisional hernias has not been previously investigated.
Purpose of the Study:
- To investigate if caesarean section (CS) is a significant risk factor for developing incisional hernias.
- To quantify the association between the number of CS and the risk of incisional hernia repair.
Main Methods:
- A population-based cohort study utilizing linked Australian birth and hospital data from 2000-2011.
- Survival analysis was employed to assess the link between CS and subsequent incisional hernia repair, adjusting for confounding variables.
- The primary outcome measured was the need for surgical repair of an incisional hernia.
Main Results:
- The study included 642,578 women, with 33.9% undergoing at least one CS.
- Women with a history of CS had a 0.47% rate of incisional hernia repair, compared to 0.12% for those without CS.
- An adjusted hazard ratio of 2.73 indicated a significantly higher risk of incisional hernia repair following CS, with risk increasing substantially with multiple CS procedures.
Conclusions:
- A strong correlation exists between maternal caesarean sections and the subsequent need for incisional hernia repair.
- The risk of incisional hernia repair escalates with an increasing number of caesarean sections.
- Despite the strong association, the absolute risk of requiring incisional hernia repair remains low.
