Evaluation of the Factors Related to Strangulation and Mortality in Patients with Incarcerated Abdominal Wall Hernias

AbstractBackground: Patients with incarcerated abdominal wall hernias (AWHs) are often encountered in emergency care units. Despite advances in anesthesia, antisepsis, antibiotic therapy, and fluid therapy, the morbidity and mortality rates for these patients remain high.Objectives: In this five-year study, the authors aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery for incarcerated abdominal wall hernias.Methods: Participants of this study included patients referring to the emergency department with an incarcerated abdominal wall hernia(incisional, umbilical, femoral, or inguinal) between October 2015 and October 2019. The presence of intraoperative ischemia and necrosis was defined as “strangulation”. Based on the presence or absence of strangulation in the incarcerated segment, patients were divided into two groups: Group 1 (non-strangulated) and Group 2 (strangulated). The following factors were determined with univariate and multivariate analyses between the two groups: length of time between incarceration and hospital admission, demographic characteristics and clinical data, physical examination findings, and risk factors for strangulation and mortality.Results: A total of 161 patients were selected for this study. Group 1 consisted of 119 patients and Group 2 consisted of 42 patients. In multivariate analysis, the prominent risk factors for strangulation were: high American Society of Anesthesiologists score (P=0.008), acute abdomen findings with distension and elevated body temperature (P<0.001), delayed hospital admission (P<0.001), procalcitonin level of >0.5 ng/mL (P<0.001), D-Dimer level of >500 µg/L (P<0.001), lactate level of >2 mmol/L (P<0.001), and creatinine level of >2 mg/dl (P<0.001). The leading risk factors for mortality were the presence of strangulation (P<0.001), lactate level of >2 mg/dL (P=0.004), and ASA scores of >3 (P=0.035).Conclusion: The most significant risk factors for strangulation were delay of more than 48 h in hospital admission, as well as high levels of procalcitonin, creatinine, lactate, and D-Dimer. On the other hand, significant risk factors for mortality were strangulation, as well as high lactate levels and ASA scores. Mortality rates may be lowered with an earlier diagnosis, more specifically, one made before the development of metabolic and radiologic impairment.Keywords: Hernia, Incarceration, Morbidity, Mortality, Strangulation