{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T16:19:41Z","timestamp":1777133981463,"version":"3.51.4"},"reference-count":49,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,21]],"date-time":"2022-08-21T00:00:00Z","timestamp":1661040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The goal of this study was to identify risk factors that are associated with mortality in adult and elderly patients who were hospitalized for umbilical hernia. A total of 14,752 adult patients (ages 18\u201364 years) and 6490 elderly patients (ages 65+), who were admitted emergently for umbilical hernia, were included in this retrospective cohort study. The data were gathered from the National Inpatient Sample (NIS) 2005\u20132014 database. Predictors of mortality were identified via a multivariable logistic regression, in patients who underwent surgery and those who did not for adult and elderly age groups. The mean (SD) ages for adult males and females were 48.95 (9.61) and 46.59 (11.35) years, respectively. The mean (SD) ages for elderly males and females were 73.62 (6.83) and 77.31 (7.98) years, respectively. The overall mortality was low (113 or 0.8%) in the adult group and in the elderly group (179 or 2.8%). In adult patients who underwent operation, age (OR = 1.066, 95% CI: 1.040\u20131.093, p &lt; 0.001) and gangrene (OR = 5.635, 95% CI: 2.288\u201313.874, p &lt; 0.001) were the main risk factors associated with mortality. Within the same population, female sex was found to be a protective factor (OR = 0.547, 95% CI: 0.351\u20130.854, p = 0.008). Of the total adult sample, 43% used private insurance, while only 18% of patients in the deceased population used private insurance. Conversely, within the entire adult population, only about 48% of patients used Medicare, Medicaid, or self-pay, while these patients made up 75% of the deceased group. In the elderly surgical group, the main risk factors significantly associated with mortality were frailty (OR = 1.284, 95% CI: 1.105\u20131.491, p = 0.001), gangrene (OR = 13.914, 95% CI: 5.074\u201338.154, p &lt; 0.001), and age (OR = 1.034, 95% CI: 1.011\u20131.057, p = 0.003). In the adult non-operation group, hospital length of stay (HLOS) was a significant risk factor associated with mortality (OR = 1.077, 95% CI: 1.004\u20131.155, p = 0.038). In the elderly non-operation group, obstruction was the main risk factor (OR = 4.534, 95% CI: 1.387\u201314.819, p = 0.012). Elderly patients experienced a 3.5-fold higher mortality than adult patients who were emergently admitted with umbilical hernia. Increasing age was a significant risk factor of mortality within all patient populations. In the adult surgical group, gangrene, Medicare, Medicaid, and self-pay were significant risk factors of mortality and female sex was a significant protective factor. In the adult non-surgical group, HLOS was the main risk factor of mortality. In the elderly population, frailty and gangrene were the main risk factors of mortality within the surgical group, and obstruction was the main risk factor for the non-surgical group.<\/jats:p>","DOI":"10.3390\/ijerph191610402","type":"journal-article","created":{"date-parts":[[2022,8,21]],"date-time":"2022-08-21T22:23:13Z","timestamp":1661120593000},"page":"10402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients"],"prefix":"10.3390","volume":"19","author":[{"given":"Saral","family":"Patel","sequence":"first","affiliation":[{"name":"Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abbas","family":"Smiley","sequence":"additional","affiliation":[{"name":"Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cailan","family":"Feingold","sequence":"additional","affiliation":[{"name":"Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bardia","family":"Khandehroo","sequence":"additional","affiliation":[{"name":"Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agon","family":"Kajmolli","sequence":"additional","affiliation":[{"name":"Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rifat","family":"Latifi","sequence":"additional","affiliation":[{"name":"Minister of Health, Republic of Kosova, Adjunct Professor of Surgery, University of Arizona, Tucson, AZ 10000, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,21]]},"reference":[{"key":"ref_1","first-page":"405","article-title":"Mr. Edwards, on Umbilical Hernia","volume":"20","author":"Edwards","year":"1808","journal-title":"Med. Phys. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.amjsurg.2006.08.022","article-title":"Predictors of recurrence in Veteran patients with umbilical hernia: Single center experience","volume":"192","author":"Asolati","year":"2006","journal-title":"Am. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/BF01194437","article-title":"Current concepts on adult umbilical hernia","volume":"3","author":"Velasco","year":"1999","journal-title":"Hernia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/S0039-6109(03)00119-1","article-title":"Umbilical and epigastric hernia repair","volume":"83","author":"Muschaweck","year":"2003","journal-title":"Surg. Clin. N. Am."},{"key":"ref_5","unstructured":"(2022, August 07). Umbilical Hernia-Abstract-Europe PMC. Available online: https:\/\/europepmc.org\/article\/NBK\/nbk459312."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s10029-015-1376-3","article-title":"The prevalence of umbilical and epigastric hernia repair: A nationwide epidemiologic study","volume":"19","author":"Burcharth","year":"2015","journal-title":"Hernia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1002\/bjs.1800840721","article-title":"Hernia repair in elderly patients","volume":"84","author":"Gianetta","year":"1997","journal-title":"Br. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Compagna, R., Rossi, R., Fappiano, F., Bianco, T., Accurso, A., Danzi, M., Massa, S., Aprea, G., and Amato, B. (2013). Emergency groin hernia repair: Implications in elderly. BMC Surg., 13.","DOI":"10.1186\/1471-2482-13-S2-S29"},{"key":"ref_9","unstructured":"(2022, January 09). 2010 ICD-9-CM Diagnosis Code 551.1: Umbilical Hernia with Gangrene. Available online: http:\/\/www.icd9data.com\/2010\/Volume1\/520-579\/550-553\/551\/551.1.htm."},{"key":"ref_10","unstructured":"(2022, January 09). 2010 ICD-9-CM Diagnosis Code 552.1: Umbilical Hernia with Obstruction. Available online: http:\/\/www.icd9data.com\/2010\/Volume1\/520-579\/550-553\/552\/552.1.htm."},{"key":"ref_11","unstructured":"(2022, January 09). 2010 ICD-9-CM Diagnosis Code 553.1: Umbilical Hernia without Obstruction or Gangrene. Available online: http:\/\/www.icd9data.com\/2010\/Volume1\/520-579\/550-553\/553\/553.1.htm."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1001\/jamasurg.2014.1242","article-title":"Trends in Emergent Hernia Repair in the United States","volume":"150","author":"Beadles","year":"2015","journal-title":"JAMA Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"183","DOI":"10.52198\/21.STI.39.HR1497","article-title":"Risk Factors for Mortality in Patients with Ventral Hernia Admitted Emergently: An Analysis of 48,539 Adult Patients","volume":"39","author":"Smiley","year":"2021","journal-title":"Surg. Technol. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/01.sla.0000251364.32698.4b","article-title":"Mortality After Groin Hernia Surgery","volume":"245","author":"Nilsson","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1007\/s10029-018-1841-x","article-title":"Predictors of mortality after elective ventral hernia repair: An analysis of national inpatient sample","volume":"23","author":"Khorgami","year":"2019","journal-title":"Hernia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1016\/j.amjsurg.2020.08.022","article-title":"Fix it while you can \u2026 Mortality after umbilical hernia repair in cirrhotic patients","volume":"220","author":"Hill","year":"2020","journal-title":"Am. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"305","DOI":"10.9738\/CC114.1","article-title":"Factors Affecting Morbidity and Mortality in Patients Who Underwent Emergency Operation for Incarcerated Abdominal Wall Hernia","volume":"97","author":"Gul","year":"2013","journal-title":"Int. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/ageing\/afx162","article-title":"Frailty index as a predictor of mortality: A systematic review and meta-analysis","volume":"47","author":"Kojima","year":"2018","journal-title":"Age Ageing"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1001\/archsurg.140.2.119","article-title":"Smoking Is a Risk Factor for Incisional Hernia","volume":"140","author":"Hemmingsen","year":"2005","journal-title":"Arch. Surg."},{"key":"ref_20","first-page":"596","article-title":"A five-year U.S. Army experience with 36,250 abdominal hernia repairs","volume":"56","author":"Heydorn","year":"1990","journal-title":"Am. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jss.2016.12.012","article-title":"Emergency department utilization and predictors of mortality for inpatient inguinal hernia repairs","volume":"212","author":"Mehta","year":"2017","journal-title":"J. Surg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/SLA.0b013e3181e8fd75","article-title":"Primary Payer Status Affects Mortality for Major Surgical Operations","volume":"252","author":"LaPar","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1001\/archsurg.2010.141","article-title":"Impact of Race and Socioeconomic Status on Presentation and Management of Ventral Hernias","volume":"145","author":"Bowman","year":"2010","journal-title":"Arch. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.amjsurg.2018.11.042","article-title":"Socioeconomic disparities in the complexity of hernias evaluated at Emergency Departments across the United States","volume":"218","author":"Nunez","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"206","DOI":"10.52198\/21.STI.39.HR1520","article-title":"Delayed Operation as a Major Risk Factor for Mortality Among Elderly Patients with Ventral Hernia Admitted Emergently: An Analysis of 33,700 Elderly Patients","volume":"39","author":"Latifi","year":"2021","journal-title":"Surg. Technol. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/S0002-9610(01)00765-6","article-title":"Emergency hernia repairs in elderly patients","volume":"182","author":"Kulah","year":"2001","journal-title":"Am. J. Surg."},{"key":"ref_27","first-page":"259","article-title":"Ventral incisional hernias: Incidence, date of recurrence, localization and risk factors","volume":"18","author":"Regnard","year":"1988","journal-title":"Ital. J. Surg. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10029-007-0226-3","article-title":"Factors affecting morbidity and mortality in incarcerated abdominal wall hernias","volume":"11","author":"Derici","year":"2007","journal-title":"Hernia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1001\/archsurg.2012.1663","article-title":"Umbilical Hernia Repair in Patients With Signs of Portal Hypertension: Surgical Outcome and Predictors of Mortality","volume":"147","author":"Cho","year":"2012","journal-title":"Arch. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1001\/jamasurg.2016.5052","article-title":"Factors Associated With Long-term Outcomes of Umbilical Hernia Repair","volume":"152","author":"Shankar","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_31","unstructured":"Doherty, G.M. (2015). Hernias & Other Lesions of the Abdominal Wall. CURRENT Diagnosis & Treatment: Surgery, McGraw-Hill Education. Available online: Accessmedicine.mhmedical.com\/content.aspx?aid=1105491643."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/SLE.0000000000000891","article-title":"Umbilical Hernia Repair in Cirrhotic Patients With Ascites: A Systemic Review of Literature","volume":"31","author":"Guo","year":"2020","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_33","first-page":"85","article-title":"The Risk of Mortality in Geriatric Patients with Emergent Gastroparesis is 7-fold Greater than that in Adult Patients: An Analysis of 27,000 Patients","volume":"40","author":"Hirani","year":"2022","journal-title":"Surg. Technol. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1177\/00031348211060420","article-title":"Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids","volume":"88","author":"Levy","year":"2022","journal-title":"Am. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1177\/00031348211054074","article-title":"Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers","volume":"88","author":"Lin","year":"2022","journal-title":"Am. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Elgar, G., Smiley, A., and Latifi, R. (2022). Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148729"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Levy, L., Smiley, A., and Latifi, R. (2022). Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159031"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Levy, L., Smiley, A., and Latifi, R. (2022). Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159203"},{"key":"ref_39","first-page":"422","article-title":"Higher Patient Complexities are Associated with Increased Length of Stay, Complications, and Readmissions After Total Hip Arthroplasty","volume":"38","author":"Guntaka","year":"2021","journal-title":"Surg. Technol. Int."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Elgar, G., Smiley, P., Smiley, A., Feingold, C., and Latifi, R. (2022). Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19169905"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1007\/s00464-016-5052-1","article-title":"Umbilical hernias: The cost of waiting","volume":"31","author":"Strosberg","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/SLA.0000000000002507","article-title":"Management of Reducible Ventral Hernias: Clinical Outcomes and Cost-effectiveness of Repair at Diagnosis Versus Watchful Waiting","volume":"269","author":"Wolf","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.surg.2014.09.017","article-title":"Watchful waiting in incisional hernia: Is it safe?","volume":"157","author":"Verhelst","year":"2015","journal-title":"Surgery"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/BF01194428","article-title":"Mortality after elective and emergency surgery for inguinal and femoral hernia","volume":"3","author":"Haapaniemi","year":"1999","journal-title":"Hernia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s10029-019-02047-y","article-title":"Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction","volume":"24","author":"Joseph","year":"2020","journal-title":"Hernia"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Lin, H.-S., Watts, J.N., Peel, N.M., and Hubbard, R.E. (2016). Frailty and post-operative outcomes in older surgical patients: A systematic review. BMC Geriatr., 16.","DOI":"10.1186\/s12877-016-0329-8"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.amjsurg.2018.11.020","article-title":"Impact of Frailty on Outcomes in Surgical Patients: A Systematic Review and Meta-analysis","volume":"218","author":"Panayi","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"158S","DOI":"10.1378\/chest.115.suppl_2.158S","article-title":"Special Problems in the Elderly","volume":"115","author":"Oskvig","year":"1999","journal-title":"Chest"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"161","DOI":"10.9738\/INTSURG-D-15-00261.1","article-title":"Surgery of the Elderly Patient","volume":"101","author":"Karakoc","year":"2016","journal-title":"Int. Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10402\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:13:03Z","timestamp":1760141583000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,21]]},"references-count":49,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph191610402"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191610402","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,21]]}}}