Perioperative risks and risk factors in patients with cirrhosis undergoing abdominal wall hernia repair: A population-level analysis.

Abstract

Abdominal wall hernias are common in patients with cirrhosis and associated with increased perioperative risk. Our objective was to describe the perioperative outcomes and risk factors in a contemporary population of patients with cirrhosis undergoing hernia repair. A retrospective, population study on adult patients with cirrhosis undergoing abdominal wall hernia surgery in Ontario between 2009 and 2018. Outcomes included 90-day mortality, postoperative liver decompensation events, complications, and blood transfusions. Adjusted relative risks were estimated from Poisson regression models for mortality and postoperative liver decompensation events. We identified 6,040 adults with cirrhosis who underwent hernia repair (inguinal, n = 2,494; umbilical, n = 1,199; ventral/incisional, n = 1,893; incarcerated, n = 454). Median age was 61 years, 76% were male, and 79% underwent elective operation. Overall mortality was 4% (15.5% for emergency repair, 1.1% for elective). Factors associated with 90-day mortality were age, hepatitis C or alcohol-associated cirrhosis, Charlson Comorbidity Index, emergent operation, Model for End-Stage Liver Disease-Sodium, and noninguinal hernia. In those undergoing elective surgery, factors associated with mortality included age, Charlson Comorbidity Index, hepatitis C, ventral/incisional hernia, and Model for End-Stage Liver Disease-Sodium. Factors associated with increased risk of 90-day postoperative liver decompensation events included a history of previous liver decompensation and Model for End-Stage Liver Disease-Sodium score. Complications occurred in 12.5% (23.8% emergency, 9.5% elective); surgical-site infection (15.0% and 4.8%), venous thromboembolism (2.4% and 0.7%), and blood product transfusion (42.4% and 4.7%). Emergency hernia repair in patients with cirrhosis is associated with increased complications, including an 8-fold increased risk of mortality, compared to elective surgery. These data support elective hernia repair in most patients with cirrhosis, taking into consideration age, other comorbidities, cirrhosis etiology and severity.