Incidence and risk factors of incisional hernia formation following abdominal organ transplantation
Background Hernia formation is common following abdominal operations, and transplant patients are at increased risk due to postoperative immunosuppression. The purpose of this study was to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation a...
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| Veröffentlicht in: | Surgical endoscopy 2015-02, Vol.29 (2), p.398-404 |
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| creator | Smith, Carter T. Katz, Micah G. Foley, David Welch, Bridget Leverson, Glen E. Funk, Luke M. Greenberg, Jacob A. |
| description | Background
Hernia formation is common following abdominal operations, and transplant patients are at increased risk due to postoperative immunosuppression. The purpose of this study was to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation.
Methods
We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation.
Results
A total of 3,460 transplants were performed during the study period: 2,247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5 %. The Kaplan–Meier rates of hernia formation at 1, 5, and 10 years were 2.5, 4.9, and 7.0 % for kidney; 4.5, 13.6, and 19.0 % for liver; and 2.5, 12.7, and 21.8 % for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function, and withholding a calcineurin inhibitor or mycophenolate mofetil (MMF) were associated with hernia formation in the kidney group. SSI and BMI >25 were associated with hernia formation in the liver group. In the pancreas group, SSI, cyclosporine, and withholding MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups. Hazard ratio: kidney = 24.71 (13.00–46.97); liver = 12.0 (6.40–22.52); pancreas = 12.95 (2.78–60.29).
Conclusion
Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia 5 years after liver or pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation. |
| doi_str_mv | 10.1007/s00464-014-3682-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1652404000</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3556613451</sourcerecordid><originalsourceid>FETCH-LOGICAL-c555t-dc8c192b012538ed481d9f96e933d8ff8b424deda3d4223d88dcedafd63e9fd53</originalsourceid><addsrcrecordid>eNp1kclKBDEQhoMoOi4P4EUCXry0Zu1JH0XcQPCi55DJMka7kzHpQXx7axwVETwlqfrqr0r9CB1SckoJmZ5VQkQrGkJFw1vFGrWBJlRw1jBG1SaakI6Thk07sYN2a30mgHdUbqMdJimTkJ0ge5tsdD5Zj01yuMT6goOxYy4V54AjZGvMyfT4yZcUDQ65DGaEENz6Pr_FNMdm5vIQV1Auc5PwWEyqi96k8ZPcR1vB9NUffJ176PHq8uHiprm7v769OL9rrJRybJxVlnZsRmA2rrwTiroudK3vOHcqBDUTTDjvDHeCMQgpZ-EVXMt9F5zke-hkrbso-XXp66iHWK3vYRCfl1XTVjJBBKwB0OM_6HNeFvjBihKSCK7oFCi6pmzJtRYf9KLEwZR3TYleOaDXDmhwQK8c0Apqjr6Ul7PBu5-K75UDwNZAhVSa-_Kr9b-qHyXvkoo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1645043817</pqid></control><display><type>article</type><title>Incidence and risk factors of incisional hernia formation following abdominal organ transplantation</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Smith, Carter T. ; Katz, Micah G. ; Foley, David ; Welch, Bridget ; Leverson, Glen E. ; Funk, Luke M. ; Greenberg, Jacob A.</creator><creatorcontrib>Smith, Carter T. ; Katz, Micah G. ; Foley, David ; Welch, Bridget ; Leverson, Glen E. ; Funk, Luke M. ; Greenberg, Jacob A.</creatorcontrib><description>Background
Hernia formation is common following abdominal operations, and transplant patients are at increased risk due to postoperative immunosuppression. The purpose of this study was to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation.
Methods
We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation.
Results
A total of 3,460 transplants were performed during the study period: 2,247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5 %. The Kaplan–Meier rates of hernia formation at 1, 5, and 10 years were 2.5, 4.9, and 7.0 % for kidney; 4.5, 13.6, and 19.0 % for liver; and 2.5, 12.7, and 21.8 % for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function, and withholding a calcineurin inhibitor or mycophenolate mofetil (MMF) were associated with hernia formation in the kidney group. SSI and BMI >25 were associated with hernia formation in the liver group. In the pancreas group, SSI, cyclosporine, and withholding MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups. Hazard ratio: kidney = 24.71 (13.00–46.97); liver = 12.0 (6.40–22.52); pancreas = 12.95 (2.78–60.29).
Conclusion
Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia 5 years after liver or pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-014-3682-8</identifier><identifier>PMID: 25125093</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdomen ; Abdominal Surgery ; Body mass index ; Estimates ; Female ; Follow-Up Studies ; Gastroenterology ; Gynecology ; Hepatology ; Hernia, Abdominal - epidemiology ; Hernia, Abdominal - etiology ; Hernias ; Humans ; Incidence ; Infections ; Kidney Transplantation - adverse effects ; Kidney transplants ; Liver Transplantation - adverse effects ; Liver transplants ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Organ Transplantation - adverse effects ; Pancreas ; Pancreas Transplantation - adverse effects ; Proctology ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Surgery ; Time Factors ; Wisconsin - epidemiology</subject><ispartof>Surgical endoscopy, 2015-02, Vol.29 (2), p.398-404</ispartof><rights>Springer Science+Business Media New York 2014</rights><rights>Springer Science+Business Media New York 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c555t-dc8c192b012538ed481d9f96e933d8ff8b424deda3d4223d88dcedafd63e9fd53</citedby><cites>FETCH-LOGICAL-c555t-dc8c192b012538ed481d9f96e933d8ff8b424deda3d4223d88dcedafd63e9fd53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-014-3682-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-014-3682-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25125093$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Carter T.</creatorcontrib><creatorcontrib>Katz, Micah G.</creatorcontrib><creatorcontrib>Foley, David</creatorcontrib><creatorcontrib>Welch, Bridget</creatorcontrib><creatorcontrib>Leverson, Glen E.</creatorcontrib><creatorcontrib>Funk, Luke M.</creatorcontrib><creatorcontrib>Greenberg, Jacob A.</creatorcontrib><title>Incidence and risk factors of incisional hernia formation following abdominal organ transplantation</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Hernia formation is common following abdominal operations, and transplant patients are at increased risk due to postoperative immunosuppression. The purpose of this study was to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation.
Methods
We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation.
Results
A total of 3,460 transplants were performed during the study period: 2,247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5 %. The Kaplan–Meier rates of hernia formation at 1, 5, and 10 years were 2.5, 4.9, and 7.0 % for kidney; 4.5, 13.6, and 19.0 % for liver; and 2.5, 12.7, and 21.8 % for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function, and withholding a calcineurin inhibitor or mycophenolate mofetil (MMF) were associated with hernia formation in the kidney group. SSI and BMI >25 were associated with hernia formation in the liver group. In the pancreas group, SSI, cyclosporine, and withholding MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups. Hazard ratio: kidney = 24.71 (13.00–46.97); liver = 12.0 (6.40–22.52); pancreas = 12.95 (2.78–60.29).
Conclusion
Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia 5 years after liver or pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation.</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Body mass index</subject><subject>Estimates</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Abdominal - epidemiology</subject><subject>Hernia, Abdominal - etiology</subject><subject>Hernias</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infections</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney transplants</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver transplants</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Organ Transplantation - adverse effects</subject><subject>Pancreas</subject><subject>Pancreas Transplantation - adverse effects</subject><subject>Proctology</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Wisconsin - epidemiology</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kclKBDEQhoMoOi4P4EUCXry0Zu1JH0XcQPCi55DJMka7kzHpQXx7axwVETwlqfrqr0r9CB1SckoJmZ5VQkQrGkJFw1vFGrWBJlRw1jBG1SaakI6Thk07sYN2a30mgHdUbqMdJimTkJ0ge5tsdD5Zj01yuMT6goOxYy4V54AjZGvMyfT4yZcUDQ65DGaEENz6Pr_FNMdm5vIQV1Auc5PwWEyqi96k8ZPcR1vB9NUffJ176PHq8uHiprm7v769OL9rrJRybJxVlnZsRmA2rrwTiroudK3vOHcqBDUTTDjvDHeCMQgpZ-EVXMt9F5zke-hkrbso-XXp66iHWK3vYRCfl1XTVjJBBKwB0OM_6HNeFvjBihKSCK7oFCi6pmzJtRYf9KLEwZR3TYleOaDXDmhwQK8c0Apqjr6Ul7PBu5-K75UDwNZAhVSa-_Kr9b-qHyXvkoo</recordid><startdate>20150201</startdate><enddate>20150201</enddate><creator>Smith, Carter T.</creator><creator>Katz, Micah G.</creator><creator>Foley, David</creator><creator>Welch, Bridget</creator><creator>Leverson, Glen E.</creator><creator>Funk, Luke M.</creator><creator>Greenberg, Jacob A.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20150201</creationdate><title>Incidence and risk factors of incisional hernia formation following abdominal organ transplantation</title><author>Smith, Carter T. ; Katz, Micah G. ; Foley, David ; Welch, Bridget ; Leverson, Glen E. ; Funk, Luke M. ; Greenberg, Jacob A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c555t-dc8c192b012538ed481d9f96e933d8ff8b424deda3d4223d88dcedafd63e9fd53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Body mass index</topic><topic>Estimates</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Abdominal - epidemiology</topic><topic>Hernia, Abdominal - etiology</topic><topic>Hernias</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infections</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney transplants</topic><topic>Liver Transplantation - adverse effects</topic><topic>Liver transplants</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Organ Transplantation - adverse effects</topic><topic>Pancreas</topic><topic>Pancreas Transplantation - adverse effects</topic><topic>Proctology</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Wisconsin - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Carter T.</creatorcontrib><creatorcontrib>Katz, Micah G.</creatorcontrib><creatorcontrib>Foley, David</creatorcontrib><creatorcontrib>Welch, Bridget</creatorcontrib><creatorcontrib>Leverson, Glen E.</creatorcontrib><creatorcontrib>Funk, Luke M.</creatorcontrib><creatorcontrib>Greenberg, Jacob A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Carter T.</au><au>Katz, Micah G.</au><au>Foley, David</au><au>Welch, Bridget</au><au>Leverson, Glen E.</au><au>Funk, Luke M.</au><au>Greenberg, Jacob A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and risk factors of incisional hernia formation following abdominal organ transplantation</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2015-02-01</date><risdate>2015</risdate><volume>29</volume><issue>2</issue><spage>398</spage><epage>404</epage><pages>398-404</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Hernia formation is common following abdominal operations, and transplant patients are at increased risk due to postoperative immunosuppression. The purpose of this study was to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation.
Methods
We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation.
Results
A total of 3,460 transplants were performed during the study period: 2,247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5 %. The Kaplan–Meier rates of hernia formation at 1, 5, and 10 years were 2.5, 4.9, and 7.0 % for kidney; 4.5, 13.6, and 19.0 % for liver; and 2.5, 12.7, and 21.8 % for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function, and withholding a calcineurin inhibitor or mycophenolate mofetil (MMF) were associated with hernia formation in the kidney group. SSI and BMI >25 were associated with hernia formation in the liver group. In the pancreas group, SSI, cyclosporine, and withholding MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups. Hazard ratio: kidney = 24.71 (13.00–46.97); liver = 12.0 (6.40–22.52); pancreas = 12.95 (2.78–60.29).
Conclusion
Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia 5 years after liver or pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25125093</pmid><doi>10.1007/s00464-014-3682-8</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Abdominal Surgery Body mass index Estimates Female Follow-Up Studies Gastroenterology Gynecology Hepatology Hernia, Abdominal - epidemiology Hernia, Abdominal - etiology Hernias Humans Incidence Infections Kidney Transplantation - adverse effects Kidney transplants Liver Transplantation - adverse effects Liver transplants Male Medicine Medicine & Public Health Middle Aged Organ Transplantation - adverse effects Pancreas Pancreas Transplantation - adverse effects Proctology Proportional Hazards Models Retrospective Studies Risk Factors Surgery Time Factors Wisconsin - epidemiology |
| title | Incidence and risk factors of incisional hernia formation following abdominal organ transplantation |
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