Is expectant management warranted in patients with ventral hernias and co-morbidities? A prospective, 5 year follow-up, patient-centered study - 20/06/22
, Brenda Saucedo a, Oscar A. Olavarria a, Karla Bernardi a, Julie L. Holihan a, Tien C. Ko a, Lillian S. Kao a, Mike K. Liang bAbstract |
Background |
Our aim was to report the natural history of operative versus expectant management of patients with ventral hernias and co-morbidities at five years.
Methods |
This was a prospective observational study. Patients were managed with elective repair or expectantly, based on co-morbidities and patient/surgeon choice. Primary outcome was functional status. Patients were matched using optimal matching. Outcomes were compared using multivariable regression.
Results |
A total of 197 patients were included (78 operative, 119 expectant) with median follow-up of 5.1 (3.2–5.5) years. In the matched-cohort (n = 80), 58 vs 68% were obese, and 88% vs 95% had a major comorbidity. Both groups had similar baseline functional status (p = 0.788), but only those repaired initially had significantly improved scores at five years (p < 0.050). Half (20) of patients managed expectantly crossed over to repair, and 15% (3) were emergent/urgent.
Conclusion |
Initial repair improves long-term functional status significantly compared to expectant management. Repair by hernia experts should be considered for high-risk patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Patients managed operatively and expectantly had improved functional status over time. |
• | Improvement in expectant management group driven by conversion to repair. |
• | Repair by hernia-experts should be considered for some high-risk patients. |
Keywords : Ventral hernia, Expectant management, Non-operative management, Watchful waiting
Plan
Vol 224 - N° 1PA
P. 96-99 - juillet 2022 Retour au numéro
Article précédent
- Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic
- Eric O. Yeates, Areg Grigorian, Morgan Schellenberg, Natthida Owattanapanich, Galinos Barmparas, Daniel Margulies, Catherine Juillard, Kent Garber, Henry Cryer, Areti Tillou, Sigrid Burruss, Liz Penaloza-Villalobos, Ann Lin, Ryan Arthur Figueras, Raul Coimbra, Megan Brenner, Todd Costantini, Jarrett Santorelli, Terry Curry, Diane Wintz, Walter L. Biffl, Kathryn B. Schaffer, Thomas K. Duncan, Casey Barbaro, Graal Diaz, Arianne Johnson, Justine Chinn, Ariana Naaseh, Amanda Leung, Christina Grabar, Jeffry Nahmias
- Social vulnerability is associated with increased morbidity following colorectal surgery
- Heather Carmichael, Adam R. Dyas, Michael R. Bronsert, Dorothy Stearns, Elisa H. Birnbaum, Robert C. McIntyre, Robert A. Meguid, Catherine G. Velopulos
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?