Poor outcomes in cirrhosis-associated hernia repair: a nationwide cohort study of 32,033 patients

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Abstract
Cirrhosis is a significant marker of adverse postoperative outcome. A large national database was analyzed for abdominal wall hernia repair outcomes in cirrhotic vs. non-cirrhotic patients. Data from cirrhotics and non-cirrhotics undergoing inpatient repair of abdominal wall hernias (excluding inguinal) from 1999 to 2004 were obtained from the University HealthSystem Consortium (UHC) database. Differences (PPPP=0.64), underwent ICU admission more commonly (15.9% vs. 6%; PP=0.008), and mortality (2.5% vs. 0.2%; PPP=0.18), emergent surgery morbidity was (17.3% vs. 14.5%; P=0.04). While differences in elective surgical mortality in cirrhotics approached significance (0.6% vs. 0.1%; P=0.06), mortality was 7-fold higher in emergencies (3.8% vs. 0.5%; P<0.0001). Patients with cirrhosis carry a significant risk of adverse outcome after abdominal wall hernia repair compared to non-cirrhotics, particularly with emergent surgery. It may, however, be safer than previously thought. Ideally, patients with cirrhosis should undergo elective hernia repair after medical optimization.