Perioperative risks and risk factors in patients with cirrhosis undergoing abdominal wall hernia repair: A population-level analysis
Bibliographic record
Abstract
BACKGROUND: Abdominal wall hernias are common in patients with cirrhosis and associated with increased perioperative risk. Our objective was to describe the perioperative outcomes and risk factors in a contemporary population of patients with cirrhosis undergoing hernia repair. METHODS: A retrospective, population study on adult patients with cirrhosis undergoing abdominal wall hernia surgery in Ontario between 2009 and 2018. Outcomes included 90-day mortality, postoperative liver decompensation events, complications, and blood transfusions. Adjusted relative risks were estimated from Poisson regression models for mortality and postoperative liver decompensation events. RESULTS: We identified 6,040 adults with cirrhosis who underwent hernia repair (inguinal, n = 2,494; umbilical, n = 1,199; ventral/incisional, n = 1,893; incarcerated, n = 454). Median age was 61 years, 76% were male, and 79% underwent elective operation. Overall mortality was 4% (15.5% for emergency repair, 1.1% for elective). Factors associated with 90-day mortality were age, hepatitis C or alcohol-associated cirrhosis, Charlson Comorbidity Index, emergent operation, Model for End-Stage Liver Disease-Sodium, and noninguinal hernia. In those undergoing elective surgery, factors associated with mortality included age, Charlson Comorbidity Index, hepatitis C, ventral/incisional hernia, and Model for End-Stage Liver Disease-Sodium. Factors associated with increased risk of 90-day postoperative liver decompensation events included a history of previous liver decompensation and Model for End-Stage Liver Disease-Sodium score. Complications occurred in 12.5% (23.8% emergency, 9.5% elective); surgical-site infection (15.0% and 4.8%), venous thromboembolism (2.4% and 0.7%), and blood product transfusion (42.4% and 4.7%). CONCLUSION: Emergency hernia repair in patients with cirrhosis is associated with increased complications, including an 8-fold increased risk of mortality, compared to elective surgery. These data support elective hernia repair in most patients with cirrhosis, taking into consideration age, other comorbidities, cirrhosis etiology and severity.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".