Comparing Ventral Hernia Repair Outcomes in Patients With and Without Liver Insufficiency.

Abstract

<h4>Background</h4>In patients with liver insufficiency, there is a high prevalence of ventral hernias. However, the decision to proceed with elective surgery must be balanced with the increased perioperative risk in patients with liver disease. Our study aimed to compare ventral hernia repair outcomes in patients with and without liver insufficiency.<h4>Study design</h4>The patients were identified using the Abdominal Core Health Quality Collaborative. Those who underwent elective, ventral hernia repair from January 2014 until December 2023 and had at least 30-day follow-up available were included in the study. To address potential treatment-choice bias, propensity score matches were generated by matching patients with liver insufficiency with those without. Three matched controls were selected for each case.<h4>Results</h4>A total of 36460 patients were included in the study. After propensity score matching, there were 837 patients in the no liver insufficiency group and 279 in the liver insufficiency group. Patients with normal liver function had more mesh placed (85% vs 79%, p=0.037) and more mesh fixation (80% vs 72%, p=0.011). At 30-day follow-up, there were no differences in reoperation, hernia recurrence, and overall SSI, SSO, SSOPI, pulmonary embolism, deep vein thrombosis, sepsis, urinary tract infection, pneumonia, respiratory failure, post-operative bleeding, or death. The liver insufficiency group had more readmissions (8.2% vs. 4.7%, p=0.024) and longer lengths of stay (2 days vs. 1 day, p<0.001).<h4>Conclusions</h4>This study compared elective ventral hernia repair outcomes in patients with and without liver insufficiency. After the propensity score matching, the liver insufficiency group demonstrated a similar post-operative risk profile compared to patients with normal liver function. As such, patients with liver insufficiency who present with symptomatic ventral hernias may be safely offered elective repair.