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Background <p>Cirrhosis is a&#xa0;progressive liver disease associated with high morbidity and an increased surgical risk. Understanding its impact on outcomes after hernia repair is essential for risk stratification and patient counseling. This study aimed to evaluate the clinical and economic impact of cirrhosis in patients undergoing inguinal (IH) or ventral/umbilical hernia (VH) repair using a&#xa0;large nationally representative database.</p> Methods <p>In this retrospective study, adult patients admitted for IH or VH were identified from the 2012–2014 Nationwide Inpatient Sample (NIS) database across the United States and stratified based on cirrhosis status. Outcomes included postoperative mortality, complications, length of stay (LOS), number of procedures during admission, and hospitalization costs. Propensity score matching (PSM) was employed to identify comparable subpopulations to evaluate the effect of cirrhosis.</p> Results <p>The cirrhosis rates were 2.2% and 3.5% for the IH (<i>n</i> = 10,012) and VH (<i>n</i> = 26,571) cohorts, respectively. After 1:10 and 1:3 PSM for IH (195 cirrhotic and 1950 non-cirrhotic) and VH (845 cirrhotic and 2535 non-cirrhotic), respectively, cirrhotic patients had longer LOS (<i>p</i> &lt; 0.001), higher total charges (<i>p</i> &lt; 0.001), and more procedures during admission (<i>p</i> &lt; 0.001) compared to non-cirrhotic patients in both cohorts. The IH cirrhotic patients had higher rates of pneumonia (4.6% vs.&#xa0;1.7%; <i>p</i> = 0.005) and shock (1.5% vs.&#xa0;0.4%; <i>p</i> = 0.021) than IH non-cirrhotic patients, whereas cirrhotic VH patients had increased sepsis rates (2.1% vs.&#xa0;0.9%, <i>p</i> = 0.007) compared to VH non-cirrhotic patients. In-hospital mortality was significantly higher for VH repairs in cirrhotic patients (1.7% vs.&#xa0;0.3%; <i>p</i> &lt; 0.001).</p> Conclusion <p>Cirrhotic patients undergoing hernia repair face significantly higher clinical risks and economic burdens compared to non-cirrhotic patients. This study highlights the need for specialized management strategies and preoperative assessments to enhance surgical outcomes and mitigate costs for this high-risk population.</p>

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Impact of social determinants in the care of cirrhotic patients with a symptomatic hernia: a propensity score-matching analysis of surgical and economic outcomes

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Amir Ebadinejad,
  • Kaitlyn Petitpas,
  • Ya-Huei Li,
  • Juan P. Cobar,
  • Oscar K. Serrano

摘要

Background

Cirrhosis is a progressive liver disease associated with high morbidity and an increased surgical risk. Understanding its impact on outcomes after hernia repair is essential for risk stratification and patient counseling. This study aimed to evaluate the clinical and economic impact of cirrhosis in patients undergoing inguinal (IH) or ventral/umbilical hernia (VH) repair using a large nationally representative database.

Methods

In this retrospective study, adult patients admitted for IH or VH were identified from the 2012–2014 Nationwide Inpatient Sample (NIS) database across the United States and stratified based on cirrhosis status. Outcomes included postoperative mortality, complications, length of stay (LOS), number of procedures during admission, and hospitalization costs. Propensity score matching (PSM) was employed to identify comparable subpopulations to evaluate the effect of cirrhosis.

Results

The cirrhosis rates were 2.2% and 3.5% for the IH (n = 10,012) and VH (n = 26,571) cohorts, respectively. After 1:10 and 1:3 PSM for IH (195 cirrhotic and 1950 non-cirrhotic) and VH (845 cirrhotic and 2535 non-cirrhotic), respectively, cirrhotic patients had longer LOS (p < 0.001), higher total charges (p < 0.001), and more procedures during admission (p < 0.001) compared to non-cirrhotic patients in both cohorts. The IH cirrhotic patients had higher rates of pneumonia (4.6% vs. 1.7%; p = 0.005) and shock (1.5% vs. 0.4%; p = 0.021) than IH non-cirrhotic patients, whereas cirrhotic VH patients had increased sepsis rates (2.1% vs. 0.9%, p = 0.007) compared to VH non-cirrhotic patients. In-hospital mortality was significantly higher for VH repairs in cirrhotic patients (1.7% vs. 0.3%; p < 0.001).

Conclusion

Cirrhotic patients undergoing hernia repair face significantly higher clinical risks and economic burdens compared to non-cirrhotic patients. This study highlights the need for specialized management strategies and preoperative assessments to enhance surgical outcomes and mitigate costs for this high-risk population.