Back to Annual Meeting Program

Objective:
Paracolostomy hernia repair (PHR) can be a challenging procedure associated with significant morbidity and high recurrence rates. We sought to analyze the complication rate, as well as 30-day mortality among patients undergoing PHR.
Design:
Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database. Univariate analysis comparing outcomes following both elective and emergency PHR with subgroup analysis among patients > 70 years old.
Setting and Patients:
NSQIP database from 2005-2008; all patients with PHR selected by CPT code 33464.
Interventions:
None
Main Outcome Measures:
30-day mortality and infectious complications (superficial, deep and organ space surgical site infections (SSI), pneumonia, sepsis, and septic shock).
Results:
519 patients underwent PHR (mean age - 63.6 years, female - 56.0%). Seventy-four patients (14.2%) had a mesh repair. Emergency PHR, performed in 59 patients (11.4%), was associated with increased rates of organ space SSI (8.5% vs. 0.9%, p=0.0014), pneumonia (18.6% vs. 2.6%, p< 0.0001), septic shock (13.6% vs. 2.6%, p=0.0007) and death (10.2% vs. 0.9%; p=0.0002). In subgroup analysis of patients > 70 years old, these differences were amplified: organ space SSI (13.8% vs. 1.2%, p=0.0054); pneumonia (27.6% vs. 3.7%; p=0.0002), septic shock (17.2% vs. 4.3%; p=0.02), and mortality (20.7% vs. 1.9%; p=0.0005).
Conclusions:This study revealed that most PHR are performed electively. Despite recent literature advocating the potential use of mesh in this setting, we found that in practice the majority of repairs are still performed primarily. Emergency PHR is associated with significantly higher rates of infectious complications and death, especially among patients older than 70. These findings suggest paracolostomy hernias, especially in the elderly, should be considered for elective repair.