The effect of comorbidity on the results of surgical treatment of patients with primary and incisional ventral hernias
DOI:
https://doi.org/10.11603/2414-4533.2018.1.8859Keywords:
comorbidity, Charlson index, ventral hernia, postoperative ventral hernia, complications.Abstract
The aim of the work: to investigate the effect of comorbidity on the results of surgical treatment of patients with ventral and postoperative ventral hernia in order to prevent and reduce the number of complications in the early postoperative period, improve the treatment outcomes and prevent the development of relapse.
Materials and Methods. The results of research and surgical treatment of 653 patients with primary and postoperative ventral hernias have been analyzed. To evaluate the degree of comorbidity in the patients under investigation, the Charlson Index. Points were calculated depending on the information obtained during the patient’s examination, as well as from the lifts from the patient’s medical records and outpatient cards. All patients with a comorbidity index of more than 3 had functional tests after hernia and tight bandaging. 18 (2.8 %) patients, in whom during the diagnostic tests the left ventricular ejection fraction decreased by more than 10 % from the lower limit of the permissible values, or the Valsvali sample was 1.3 refused to undergo scheduled surgical intervention. A comparative analysis of the results of performed surgical interventions was carried out, depending on the type of hernia, degree of comorbidity and the method of performed surgical intervention.
Results and Discussion. The average index of Charlson in the surveyed was 4.7. An analysis of the frequency of postoperative complications in operated 635 (97.24 %) patients showed that the lowest in the group of patients with a comorbidity index less than < 2 (3.27 %). With a comorbidity index of 2–3, which was observed in 172 (27.08 %) patients, 7 (4.06 %) had a number of postoperative complications: abdominal compartment syndrome in 2 (1.16 %), postoperative pneumonia in 1 (0.58 %). At the same time, only 1 (0.58 %) of the group of patients who underwent non-stretching hernioplasty suppurated the postoperative wound. Among 240 (37.79 %) operated with a comorbidity index of 3–4, and the closure of a hernial defect with tension, the number of postoperative complications was 10 (4.16 %) and was significantly higher than in patients operated with plastic without tension 3 (1.28 %), respectively. In patients with performed hernioplasty without tension and a comorbidity index of 5–6, the percentage of complications 5 (11.36 %) was five times lower than in patients who underwent tension hernioplasty 25 (56.81 %), respectively. In most patients with a comorbidity index > 6, several postoperative complications occurred simultaneously. The results of the studies show a high incidence of complications from the cardiovascular system 7 (1.10 %), the emergence of the abdominal compartment of syndrome 13 (2.04 %), postoperative pneumonia 11 (1.73 %) and recurrent hernias 26 (4.09 %) in the group of patients operated by stretching methods of performing hernioplasty with a comorbidity index from 4 to 6 an d more.
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