Trends in emergent hernia repair in the United States

Abstract

Importance Abdominal wall hernia is one of the most common conditions encountered by general surgeons. Rising rates of abdominal wall hernia repair have been described; however, population-based evidence concerning incidence rates of emergent hernia repair and changes with time are unknown.

Objective To examine trends in rates of emergent abdominal hernia repair within the United States for inguinal, femoral, ventral, and umbilical hernias from January 1, 2001, to December 31, 2010.

Design, Setting, and Participants A retrospective analysis of adults with emergent hernia repair using National Center for Health Statistics data, a nationally representative sample of inpatient hospitalizations in the United States that occurred from January 1, 2001, to December 31, 2010. All emergent hernia repairs were identified during the study period.

Main Outcomes and Measures Incidence rates per 100?000 person-years, age, and sex adjusted to the 2010 US census population estimates were calculated for selected subcategories of emergent hernia repairs and time trends were evaluated.

Results An estimated 2.3 million inpatient abdominal hernia repairs were performed from 2001 to 2010; of which an estimated 567?000 were performed emergently. A general increase in the rate of total emergent hernias was observed from 16.0 to 19.2 emergent hernia repairs per 100?000 person-years in 2001 and 2010, respectively. In 2010, emergent hernia rates were highest among adults 65 years and older, with 71.3 and 42.0 emergent hernia repairs per 100?000 person-years for men and women, respectively. As expected, femoral hernia rates were higher among women while emergent inguinal hernia rates were higher among men. Rates of emergent incisional hernia repair were high but relatively stable among older women, with 24.9 and 23.5 per 100?000 person-years in 2001 and 2010, respectively. However, rates of emergent incisional hernia repair among older men rose significantly, with 7.8 to 32.0 per 100?000 person-years from 2001 to 2010, respectively.

Conclusions and Relevance These increasing rates of emergent incisional hernia repair are troublesome owing to the significantly increased risk morbidity and mortality associated with emergent hernia repair. While this increased mortality risk is multifactorial, it is likely associated with older age and the accompanying serious comorbidities.