Abdominal Wall Hernias in Patients with Hiatal Hernias: Predictors of Association in a Large Cohort of Patients

Nisarg Mehta, Sven E. Eriksson, P. Zheng, I. Sarici, A. Zaidi, B. Jobe, S. Ayazi
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Abstract

Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P <0 .0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P <0 .0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P < 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P <0 .0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P <0 .0001). The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.
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Hiatal疝患者的腹壁疝:一组患者中相关性的预测因素
先天性疝和腹壁疝在发病机制和病因上有着共同的主题。这表明这两种类型的疝之间存在潜在的关系。然而,没有大型研究对这种关联进行过研究。我们设计了当前的研究来描述这种关联,并确定与这种共存相关的因素。在一个服务于美国大西洋中部地区3个州的大型多中心健康网络的患者数据库中,查询了有记录的裂孔疝(HH)或食管旁疝(PEH)诊断患者。然后,根据他们是否有另一种类型的AWH(腹侧疝、腹股沟疝/股疝、脐疝或切口疝)的病史,将该人群分为几组。使用单变量,然后进行多变量逻辑分析,比较各组之间的人口统计学和临床数据。最终研究人群包括28人 114例HH/PEH患者(女性66.5%)。该人群中AWH的患病率为8.2%(n = 2299)。其中69.1%的患者只有一次AWH,其余30.9%的患者有两次或两次以上疝。多因素分析显示,患有HH/PEH的男性患者更有可能患有AWH(OR:1.97;95%CI:1.810-2.162,P <0 .0001)。50至80岁的患者发生AWH的几率更高 与年轻患者相比(OR:1.527;95%CI:1.348-1.730,P <0 .0001)。有任何合并症的患者也更有可能发展为AWH(OR:1.764;95%CI:1.566-1.986,P < 0.0001),阻塞性睡眠呼吸暂停(OSA)是风险最高的合并症(OR:1.295;95%CI:1.111-1.444,P <0 .0001),其次是肥胖(OR:1.267;95%CI:1.156-1.388,P <0 .0001)。HH/PEH患者的AWH患病率为8.2%。尽管HH/PEH在女性中更为普遍,但患有HH/PEH的男性患AWH的风险更高。肥胖、OSA、吸烟、高血压、糖尿病和甲状腺功能减退是HH/PEH患者出现AWH的独立风险因素。
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