Factors of selection and failure of ambulatory incisional hernia repair: A cohort study of 1429 patients - 22/07/18

Doi : 10.1016/j.jviscsurg.2018.07.001

F. Drissi ^a,^⁎ , J.F. Gillion ^b, J.P. Cossa ^c, F. Jurczak ^d, C. Baayen ^e
for
“Club Hernie”
^a Clinique de chirurgie digestive et endocrinienne (CCDE), Institut des maladies de l’appareil digestif (IMAD), Hôtel Dieu, CHU de Nantes, place Ricordeau, 44093 Nantes cedex 1, France
^b Unité de chirurgie viscérale et digestive, hôpital privé d’Antony, 1, rue Velpeau, 92160 Antony, France
^c Chirurgie générale et digestive, CMC Georges-Bizet, 23, rue Georges-Bizet, 75116 Paris, France
^d Chirurgie générale et digestive, clinique mutualiste de l’estuaire, cité sanitaire, 11, boulevard Georges-Charpak, 44606 Saint-Nazaire, France
^e Capionis, 183 avenue de Choisy, 75013 Paris, France

^⁎Corresponding author.

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Summary

Background

Ambulatory surgery for incisional hernia repair (IHR) is not a widespread practice and is mainly performed for small incisional hernias.

Aim

To assess outpatient IHR practice in France and to identify predictive factors of selection and failure of ambulatory procedures.

Method

Surgeons of the French “Club Hernie” prospectively gathered data concerning IHR over a period of almost 5years within a nationwide database.

Results

A number of patients (1429) were operated on during the period of the study. The mean age was 63.3 (22–97) years old. An ambulatory procedure was planned in 305 (21%) patients. Among these, 272 (89%) IHR were effectively performed as one-day procedures. Upon multivariate analysis, predictive factors influencing practitioners for not propose an ambulatory care were increasing age (OR 0.97, P<0.001), body mass index (OR 0.95, P<0.001), ASA grade≥III (OR 0.23, P<0.001), hernia width≥4cm (OR 0.44, P<0.001), recurrent hernia (OR 0.55, P=0.01) and a laparoscopic IHR (OR 0.54, P<0.001). A number of patients (1157) were not selected preoperatively for outpatient IHR mainly because of organizational issues or an ASA grade≥III. Medical or social reasons were the main causes of failure of initially planned ambulatory settings.

Conclusion

Ambulatory IHR is a safe and feasible practice subject to a good preoperative selection of the patients. Increasing age, body mass index, ASA grade≥III, hernia width≥4cm, recurrent hernia and a laparoscopic IHR were identified to be preoperative factors for not proposing an ambulatory care. One-day surgery for IHR could be systematically proposed for IHR of small incisional hernias (<4cm) in young patients with few comorbidities.

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Keywords : Incisional hernia repair, One-day surgery, Ambulatory