Risk of morbidity, mortality, and recurrence after parastomal hernia repair: a nationwide study.

Abstract

Surgical outcome results after repair for parastomal hernia are sparsely reported and based on small-scale studies. This study aims to analyze surgical risk factors for 30-day reoperation and mortality, and, secondarily, to report the risk of reoperation for recurrence. This is a retrospective analysis of nationwide perioperative surgical variables. The primary outcome was reoperation for surgical complications and/or mortality within 30 days after parastomal hernia repair. Follow-up was obtained from the Danish National Patient Register. Detailed patient-related data were based on hospital files. Multivariate analysis was based on a compound parameter: 30-day reoperation or death. All patients with a parastomal hernia repair registered in the Danish Hernia Database from January 1, 2007 to December 31, 2010 were included. Univariate and logistic regression was used to identify risk factors for 30-day reoperation or death. The study included 174 patients with a parastomal hernia repair (142 elective and 32 emergency repairs; 56 open and 118 laparoscopic repairs). Median follow-up was 20 months (range, 0-47). A total of 13.2% were reoperated because of postoperative complications, and 6.3% of patients died within the first 30 postoperative days. Emergency repair was the strongest risk factor for reoperation or death in multivariate analyses (OR, 7.6; 95% CI, 2.7-21.5). No difference was found in preoperative risk of poor outcome between elective and emergency repairs (Charlson score 4 (range, 0-12) vs 5 (0-11), p = 0.07). After 3 years, the cumulated reoperation rate for recurrence was 10.8% (open 17.2% and laparoscopic 3.8%). Patients' comorbidity was based on retrospective data, and the study had a relatively short follow-up. In the present nationwide study, repair for a parastomal hernia was associated with high rates of morbidity, mortality, and repair for recurrence. Emergency repair was the only important risk factor to predict poor 30-day postoperative outcome.