Evaluation of mortality risk and surgical outcomes based on Charlson comorbidity index in emergency hernia repair patients

Abstract

CONTEXT: Hernias are common surgical conditions that may require emergency interventions due to complications such as strangulation, bowel obstruction, or ischemia. These situations significantly impact clinical outcomes and necessitate robust risk assessment tools.

AIMS: To evaluate mortality risk and surgical outcomes in emergency hernia repair patients using the Charlson comorbidity index (CCI) and to optimize clinical decision-making processes.

SETTINGS AND DESIGN: A retrospective study conducted at our General Surgery Clinic from 2021 to 2023.

MATERIALS AND METHODS: Data from 159 patients undergoing emergency hernia surgery were retrospectively analyzed. Variables included demographic data, hernia types, surgical interventions, and clinical outcomes. CCI and American Society of Anesthesiologists scores were calculated, and their impacts on mortality were assessed using logistic regression and chi-square tests.

STATISTICAL ANALYSIS USED: Logistic regression, chi-square tests, and cross-tabulation analyses.

RESULTS: Patients with a CCI score of 3-4 showed a significantly higher mortality risk (P = 0.000), while those with scores ≥5 exhibited elevated but statistically insignificant mortality risks (P = 0.141). Mortality was significantly associated with intestinal resection (P = 0.001). The time of presentation correlated with the likelihood of requiring resection (P = 0.000).

CONCLUSION: CCI is a reliable predictor of mortality risk in emergency hernia repair patients. Early risk assessment and timely intervention are crucial for improving outcomes.

Keywords

ASA score / Charlson comorbidity index / emergency hernia repair / mortality risk / surgical outcomes

References

[1] Ali IM , Shetty K S , Shetty V . A clinical study of anterior abdominal wall hernias and its management: A medical college experience. Cureus 2024; 16: e67209.

[2] Lindmark M , Strigård K , Löwenmark T , Dahlstrand U , Gunnarsson U . Risk factors for surgical complications in ventral hernia repair. World J Surg 2018; 42: 3528- 36.

[3] Pandya B , Huda T , Gupta D , Mehra B , Narang R . Abdominal wall hernias: An epidemiological profile and surgical experience from a rural medical college in central India. Surg J (N Y) 2021; 7: e41- 6.

[4] Qu WF , Zhou PY , Liu WR , Tian MX , Jin L , Jiang XF , et al. Ageadjusted Charlson Comorbidity Index predicts survival in intrahepatic cholangiocarcinoma patients after curative resection. Ann Transl Med 2020; 8: 487.

[5] Dhakal P , Shostrom V , Al-Kadhimi ZS , Maness LJ , Gundabolu K , Bhatt VR . Usefulness of Charlson comorbidity index to predict early mortality and overall survival in older patients with acute myeloid leukemia. Clin Lymphoma Myeloma Leuk 2020; 20: 804- 12.e8.

[6] Leeds IL , Jones C , DiBrito SR , Sakran JV , Haut ER , Kent AJ . Delay in emergency hernia surgery is associated with worse outcomes. Surg Endosc 2020; 34: 4562- 73.

[7] Charlson ME , Carrozzino D , Guidi J , Patierno C . Charlson comorbidity index: A critical review of clinimetric properties. Psychother Psychosom 2022; 91: 8- 35.

[8] Comoglu S , Kant A . Does the Charlson comorbidity index help predict the risk of death in COVID-19 patients? North Clin Istanb 2022; 9: 117- 21.

[9] Yurtlu DA , Aksun M , Ayvat P , Karahan N , Koroglu L , Aran G . Comparison of risk scoring systems to predict the outcome in ASA-PS V patients undergoing surgery: A retrospective cohort study. Medicine (Baltimore) 2016; 95: e3238.

[10] Hackett NJ , De Oliveira GS , Jain UK , Kim JY . ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 2015; 18: 184- 90.

[11] Cher EWL , Carson JA , Sim EY , Abdullah HR , Howe TS , Bee JKS . Developing a simpler prognosticating tool: Comparing the combined assessment of risk encountered in surgery score with Deyo-Charlson comorbidity index and the American society of anesthesiologists physical status score in predicting 2 years mortality after hip fracture surgery. Geriatr Orthop Surg Rehabil 2021; 12: 21514593211036235.

[12] McCoy CC , Englum BR , Keenan JE , Vaslef SN , Shapiro ML , Scarborough JE . Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg 2015; 78: 912- 8; discussion 918.

[13] Singh A , Paruthy SB , Aradhya PS , Chavda J , Pal S . Rare hernias as surgical emergencies: A case series of five cases. Cureus 2023; 15: e41064.

[14] Sartelli M , Coccolini F , Van Ramshorst GH , Campanelli G , Mandalà V , Ansaloni L , et al. WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 2013; 8: 1- 11.

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press