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  1. Article ; Online: Surgical site infections after emergency hernia repair: substudy from the Management of Acutely Symptomatic Hernia (MASH) study.

    Proctor, Victoria K / O'Connor, Olivia M / Burns, Flora A / Green, Susie / Sayers, Adele E / Hawkins, Deborah J / Smart, Neil J / Lee, Matthew J

    BJS open

    2023  Volume 7, Issue 1

    Abstract: Introduction: Acutely symptomatic abdominal wall and groin hernias (ASH) are a common acute surgical presentation. There are limited data to guide decisions related to surgical repair technique and use of antibiotics, which can be driven by increased ... ...

    Abstract Introduction: Acutely symptomatic abdominal wall and groin hernias (ASH) are a common acute surgical presentation. There are limited data to guide decisions related to surgical repair technique and use of antibiotics, which can be driven by increased risk of surgical site infection (SSI) in this group. This study aims to report rates of SSI following ASH repair and explore the use of patient-reported outcome measure reporting in this setting.
    Methods: An 18-week, UK-based, multicentre prospective cohort study (NCT04197271) recruited adults with ASH. This study reports operatively managed patients. Data on patient characteristics, inpatient management, quality of life, complications, and wound healing (Bluebelle score) were collected. Descriptive analyses were performed to estimate event rates of SSI and regression analysis explored the relationship between Bluebelle scores and SSI. The 30 and 90-day follow-up visits assessed complications and quality of life.
    Results: The MASH study recruited 273 patients, of whom 218 were eligible for this study, 87.2 per cent who underwent open repair. Mesh was used in 123 patients (50.8 per cent). Pre- and postoperative antibiotics were given in 163 (67.4 per cent) and 28 (11.5 per cent) patients respectively. There were 26 reported SSIs (11.9 per cent). Increased BMI, incisional, femoral, and umbilical hernia were associated with higher rates of SSI (P = 0.006). In 238 patients, there was a difference in healthy utility values at 90 days between patients with and without SSI (P = 0.025). Also, when analysing 191 patients with Bluebelle scores, those who developed an SSI had higher Bluebelle values (P < 0.001).
    Conclusion: SSI is frequent in repair of acutely symptomatic hernia and correlates with BMI and site of hernia.
    MeSH term(s) Adult ; Humans ; Anti-Bacterial Agents/therapeutic use ; Herniorrhaphy/adverse effects ; Prospective Studies ; Quality of Life ; Surgical Wound Infection/epidemiology ; Patient Reported Outcome Measures ; United Kingdom/epidemiology ; Emergency Medical Services ; Risk Factors
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-02-17
    Publishing country England
    Document type Clinical Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrac155
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Management of Acutely Symptomatic Hernia (MASH) study.

    Proctor, Victoria K / O'Connor, Olivia M / Burns, Flora A / Green, Susanna / Sayers, Adele E / Hawkins, Deborah J / Smart, Neil J / Lee, Matthew J

    The British journal of surgery

    2022  Volume 109, Issue 8, Page(s) 754–762

    Abstract: Background: Acutely symptomatic abdominal wall and groin hernias are a common reason for acute surgical hospital admissions. There are limited data to guide the treatment of these patients. This study aimed to assess outcomes of emergency hernia surgery ...

    Abstract Background: Acutely symptomatic abdominal wall and groin hernias are a common reason for acute surgical hospital admissions. There are limited data to guide the treatment of these patients. This study aimed to assess outcomes of emergency hernia surgery and identify common management strategies, to improve care for these high-risk patients.
    Methods: A 20-week, national multicentre, collaborative, prospective cohort study (NCT04197271) recruited adults with acutely symptomatic abdominal wall and groin hernias across the UK. Data on patient characteristics, inpatient management, quality of life, complications, and wound healing were collected. Follow-up telephone calls at 30 and 90 days were used to assessed complications and quality of life. Descriptive analyses were undertaken to describe the population and outcomes.
    Results: Twenty-three hospitals recruited 272 eligible patients. Inguinal (37.8 per cent) and umbilical (37.1 per cent) hernias were the most common. Some 13.9 per cent were awaiting elective surgery and 12.8 per cent had previously declined intervention. CT was performed in 47.1 per cent and 81.3 per cent underwent surgical management. Open repairs were carried out in 93.5 per cent, and 92.5 per cent of these were performed under general anaesthesia. Four of 13 laparoscopic procedures were converted to open surgery. Mesh was used in 55.1 per cent of repairs, typically synthetic non-absorbable (87.4 per cent). Complications were infrequent; surgical-site infection (9.4 per cent), delirium (3.2 per cent), and pneumonia (2.3 per cent) were the most common. The 90-day mortality rate was 4.9 per cent. Immediate surgical management was associated with a significant improvement in quality of life at 30 days (median score 0.73-0.82).
    Conclusion: There is variation in the investigation, management, and surgical technique used to treat acutely symptomatic abdominal wall and groin hernias in the UK. The optimal management strategy for specific acute presentations remains to be established. Presented to the Association of Surgeons in Training Conference, Birmingham, UK, March 2021, the Association of Surgeons of Great Britain and Ireland Congress, May 2021, the World Society of Emergency Surgery, Edinburgh, UK, September 2021, and the European Hernia Society Congress, Copenhagen, Denmark, October 2021.
    MeSH term(s) Adult ; Hernia, Inguinal/diagnosis ; Hernia, Inguinal/surgery ; Herniorrhaphy/methods ; Humans ; Prospective Studies ; Quality of Life ; Surgical Mesh
    Language English
    Publishing date 2022-05-24
    Publishing country England
    Document type Clinical Study ; Journal Article ; Multicenter Study
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac107
    Database MEDical Literature Analysis and Retrieval System OnLINE

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