PREDICTIVE FACTORS OF INCISIONAL HERNIA AFTER NEPHRECTOMY

Abstract

Abstract INTRODUCTION Kidney diseases’ surgical approach is multiple, tending to reduce postoperative complications such as incisional hernia, a complication with an incidence around 5-15% and which usually appears after the first year of surgery, being this the possible trigger of serious pathologies that make essential the need to identify predictive factors of its appearance. MATERIAL AND METHODS A retrospective observational study was carried out in 269 patients undergoing nephrectomy (partial or radical) or nephroureterectomy between 2004 and 2018, with the aim of identifying possible predictive factors of incisional hernia after these surgeries. Preoperative (epidemiological and comorbidities), intraoperative (type of surgery, approach and closure, duration) and postoperative data (different possible complications) were taken into account. A univariate and multivariate analysis were performed, using Chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 52.2 months (SD = 39.5), time in which 22 patients had an incisional hernia (8.2%), showing this association with preoperative and postoperative variables. As preoperative data COPD, obesity, ASA and a history of previous laparotomy were related in the univariate analysis, while only obesity was associated in the multivariate analysis (p = 0.003); among postoperative items surgical wound infection, postoperative pulmonary complication, seroma and the need for transfusion and reoperation showed association in the univariate analysis, but only surgical wound infection was the one confirmed in the multivariate analysis (p = 0.049). CONCLUSIONS Obesity and surgical wound infection were proved to be the main predictive factors for the appearance of incisional hernia after nephrectomy.