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. 2023 Apr 1;158(4):394-402.
doi: 10.1001/jamasurg.2022.7978.

Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults

Ryan Howard  1   2 , Farizah Rob  1   2 , Jyothi Thumma  1   2 , Anne Ehlers  1   2   3 , Sean O'Neill  1   2   3 , Justin B Dimick  1   2   3   4 , Dana A Telem  1   2   3
Affiliations

Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults

Ryan Howard et al. JAMA Surg. .

Abstract

Importance: Parastomal hernia is a challenging complication following ostomy creation; however, the incidence and long-term outcomes after elective parastomal hernia repair are poorly characterized.

Objective: To describe the incidence and long-term outcomes after elective parastomal hernia repair.

Design, setting, and participants: Using 100% Medicare claims, a retrospective cohort study of adult patients who underwent elective parastomal hernia repair between January 1, 2007, and December 31, 2015, was performed. Logistic regression and Cox proportional hazards models were used to evaluate mortality, complications, readmission, and reoperation after surgery. Analysis took place between February and May 2022.

Exposures: Parastomal hernia repair without ostomy resiting, parastomal hernia repair with ostomy resiting, and parastomal hernia repair with ostomy reversal.

Main outcomes and measures: Mortality, complications, and readmission within 30 days of surgery and reoperation for recurrence (parastomal or incisional hernia repair) up to 5 years after surgery.

Results: A total of 17 625 patients underwent elective parastomal hernia repair (mean [SD] age, 73.3 [9.1] years; 10 059 female individuals [57.1%]). Overall, 7315 patients (41.5%) underwent parastomal hernia repair without ostomy resiting, 2744 (15.6%) underwent parastomal hernia repair with ostomy resiting, and 7566 (42.9%) underwent parastomal hernia repair with ostomy reversal. In the 30 days after surgery, 676 patients (3.8%) died, 7088 (40.2%) had a complication, and 1740 (9.9%) were readmitted. The overall adjusted 5-year cumulative incidence of reoperation was 21.1% and was highest for patients who underwent parastomal hernia repair with ostomy resiting (25.3% [95% CI, 25.2%-25.4%]) compared with patients who underwent parastomal hernia repair with ostomy reversal (18.8% [95% CI, 18.7%-18.8%]). Among patients whose ostomy was not reversed, the hazard of repeat parastomal hernia repair was the same for patients whose ostomy was resited vs those whose ostomy was not resited (adjusted hazard ratio, 0.93 [95% CI, 0.81-1.06]).

Conclusions and relevance: In this study, more than 1 in 5 patients underwent another parastomal or incisional hernia repair within 5 years of surgery. Although this was lowest for patients who underwent ostomy reversal at their index operation, ostomy resiting was not superior to local repair. Understanding the long-term outcomes of this common elective operation may help inform decision-making between patients and surgeons regarding appropriate operative approach and timing of surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Howard reported grants from Blue Cross Blue Shield of Michigan Foundation outside the submitted work and grants from the National Institute of Diabetes and Digestive and Kidney Diseases (grant 5T32DK108740-05). Dr Dimick reported being a cofounder of ArborMetrix Inc and reports personal fees from ArborMetrix Inc outside the submitted work as well as grants from the National Institutes of Health, Agency for Healthcare Research and Quality, and Blue Cross Blue Shield of Michigan Foundation. Dr Telem reported grants from Agency for Healthcare Research and Quality during the conduct of the study and consulting fees from Medtronic. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. 30-Day Outcomes After Elective Parastomal Hernia Repair (PHR)
Risk-adjusted rates estimated using multivariable logistic regression that included patient age, sex, race, Elixhauser comorbidities, operation type (PHR without ostomy resiting, PHR with ostomy resiting, PHR with ostomy reversal), surgical approach (open vs minimally invasive), mesh use, myofascial release, and year of surgery.
Figure 2.
Figure 2.. Adjusted Cumulative Incidence of Reoperation and Repeat Parastomal Hernia Repair (PHR) Up to 5 Years After PHR
Adjusted cumulative incidence estimated from Cox proportional hazards models that included patient age, sex, race, Elixhauser comorbidities, operation type (PHR without ostomy resiting, PHR with ostomy resiting, PHR with ostomy reversal), surgical approach (open vs minimally invasive), mesh use, and myofascial release. Patients were censored if they died, disenrolled from Medicare, or reached the end of the study period.
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