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Gillespie BM, Harbeck EL, Sandy-Hodgetts K, Rattray M, Thalib L, Patel B, Andersson AE, Walker RM, Latimer S, Chaboyer WP. Incidence of wound dehiscence in patients undergoing laparoscopy or laparotomy: a systematic review and meta-analysis. J Wound Care 2023; 32:S31-S43. [PMID: 37591664 DOI: 10.12968/jowc.2023.32.sup8a.s31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Surgical wound dehiscence (SWD) is a serious complication-with a 40% estimated mortality rate-that occurs after surgical intervention. Since the implementation of advanced recovery protocols, the current global incidence of SWD is unknown. This systematic review and meta-analysis estimated the worldwide incidence of SWD and explored its associated factors in general surgical patients. Eligible full-text cross-sectional, cohort and observational studies in English, between 1 January 2010 to 23 April 2021, were retrieved from MEDLINE, CINAHL, EMBASE and the Cochrane Library. Data extraction and quality appraisal were undertaken independently by three reviewers. Random effects meta-analytic models were used in the presence of substantial inconsistency. Subgroup, meta-regression and sensitivity analyses were used to explore inconsistency. Publication bias was assessed using Hunter's plots and Egger's regression test. Of 2862 publications retrieved, 27 studies were included in the final analyses. Pooled data from 741,118 patients across 24 studies were meta-analysed. The 30-day cumulative incidence of SWD was 1% (95% Confidence Interval (CI): 1-1%). SWD incidence was highest in hepatobiliary surgery, at 3% (95% CI: 0-8%). Multivariable meta-regression showed SWD was significantly associated with duration of operation and reoperation (F=7.93 (2-10); p=0.009), explaining 58.2% of the variance. Most studies were retrospective, predated the agreed global definition for SWD and measured as a secondary outcome; thus, our results likely underestimate the scope of the problem. Wider uptake of the global definition will inform the SWD surveillance and improve the accuracy of reporting.
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Affiliation(s)
- Brigid M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
- Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Queensland, Australia
| | - Emma L Harbeck
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Kylie Sandy-Hodgetts
- School of Biomedical Sciences, University of Western Australia Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Australia
| | - Megan Rattray
- Menzies Health Institute Queensland, Griffith University, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - Bhavik Patel
- Acute Care and Trauma Surgery, Gold Coast University Hospital, Queensland, Australia
| | - Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Division of Surgery, Princess Alexandra Hospital, Queensland, Australia
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Wendy P Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
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Jolissaint JS, Dieffenbach BV, Tsai TC, Pernar LI, Shoji BT, Ashley SW, Tavakkoli A. Surgical site occurrences, not body mass index, increase the long-term risk of ventral hernia recurrence. Surgery 2020; 167:765-771. [PMID: 32063341 PMCID: PMC8186954 DOI: 10.1016/j.surg.2020.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recurrence rates after ventral hernia repair vary widely and evidence about risk factors for recurrence are conflicting. There is little evidence for risk factors for long-term recurrence. METHODS Patients who underwent ventral hernia repair at our institution and were captured in the American College of Surgeons-National Surgical Quality Improvement Program database between 2002 and 2015 were included. We reviewed all demographic, procedural, and hernia-specific data. RESULTS Six hundred and thirty patients were included for analysis with a median follow-up of 4.9 years (inter-quartile range, 2-7.3 years). By univariate analysis, index hernia repairs were more likely to recur if defect size was ≥4 cm (P = .019), no mesh was used (P = .026), or if the repair was for a recurrent hernia (P = .001). Five-year cumulative incidence of recurrence and reoperation was 24.3% and 16.0%, respectively. Patients with a perioperative surgical site occurrence, which included superficial, deep-incisional, and organ space surgical site infections as well as wound disruption, had a 5-year cumulative incidence of recurrence of 54.9% compared with 22.6% for those without surgical site occurrence. By multivariable analysis, non-primary hernia repair (hazard ratio 1.7, 95% confidence interval 1.2-2.4, P = .005) and any postoperative surgical site occurrence (hazard ratio 1.9, 95% confidence interval 1.1-3.6, P = .02) were the only risk factors predictive of recurrence. Patient body mass index had no independent effect on recurrence. CONCLUSION 1 in 4 patients undergoing an open ventral hernia repair will have a recurrence after 5 years, and this risk is doubled among patients who experience any perioperative surgical site occurrence. After controlling for patient comorbidities, including body mass index, hernia size, and mesh position, the most significant risk factor for recurrence after ventral hernia repair was a non-primary hernia and surgical site occurrence.
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Affiliation(s)
- Joshua S Jolissaint
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | | | - Thomas C Tsai
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Brent T Shoji
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Laboratory for Metabolic and Surgical Research, Brigham and Women's Hospital, Boston, MA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Laboratory for Metabolic and Surgical Research, Brigham and Women's Hospital, Boston, MA
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Baltodano PA, Chattha A, Johnson PK, Kittredge J, Ricci JA, Patel A. Postoperative Prophylactic Antibiotics Reduce Surgical Site Infection Rates after Ventral Hernia Repair: A Systematic Review. Am Surg 2019. [DOI: 10.1177/000313481908501128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SSIs after ventral hernia repair (VHR) represent a significant complication. The impact of postoperative prophylactic antibiotics on the SSI rates after VHRs is unclear. A systematic review of PubMed and Web of Science databases from inception through March 2016 investigating the effect of postoperative prophylactic antibiotics after VHRs was performed. Strict inclusion and exclusion criteria were implemented, and the methodological quality of the included studies was assessed. After systematic independent assessment of 216 citations, four studies, involving 344 patients, met the inclusion criteria. Among the included studies, 164 patients received >24 hours of postoperative prophylactic antibiotics, whereas 180 patients were controls. The overall incidence of SSI among patients receiving postoperative antibiotics was 14.6 per cent (95% confidence interval [CI], 9.9 to 20.9) which compares favorably with the control group: 35.5 per cent (95% CI, 28.9 to 42.7) (odds ratio: 0.3, 95% CI: 0.2 to 0.5, P < 0.01). Among patient's receiving postoperative antibiotics, the pooled average duration of postoperative antibiotic treatment was 6.2 ± 0.4 days. Based on the available evidence, the use of postoperative prophylactic antibiotics seems to be associated with lower SSI rates after VHRs. Future prospective randomized controlled trials should be conducted to further confirm the efficacy of this prophylactic intervention.
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Affiliation(s)
- Pablo A. Baltodano
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Anmol Chattha
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Philip K. Johnson
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Justin Kittredge
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Joseph A. Ricci
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Ashit Patel
- Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, New York
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Rubay D, Ohanisian L, White SD, Al-Musawi M. Diaphragmatic Hernia Repair Using Biosynthetic Tissue Reinforcement Patch: A Case Series Experience. Cureus 2019; 11:e4274. [PMID: 31157136 PMCID: PMC6529053 DOI: 10.7759/cureus.4274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Diaphragmatic hernias are commonly encountered by general surgeons. However, repair is often fraught with complications and recurrence. The use of extracellular matrix scaffolds for repair of damaged tissues through constructive remodeling is an effective surgical adjunct. Herein, we describe the repair of diaphragmatic hernias using GORE® BIO-A® Tissue Reinforcement patch in a series of patients.
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Affiliation(s)
- David Rubay
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Levonti Ohanisian
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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Factors of selection and failure of ambulatory incisional hernia repair: A cohort study of 1429 patients. J Visc Surg 2018; 156:85-90. [PMID: 30041906 DOI: 10.1016/j.jviscsurg.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ambulatory surgery for incisional hernia repair (IHR) is not a widespread practice and is mainly performed for small incisional hernias. AIM To assess outpatient IHR practice in France and to identify predictive factors of selection and failure of ambulatory procedures. METHOD Surgeons of the French "Club Hernie" prospectively gathered data concerning IHR over a period of almost 5years within a nationwide database. RESULTS A number of patients (1429) were operated on during the period of the study. The mean age was 63.3 (22-97) years old. An ambulatory procedure was planned in 305 (21%) patients. Among these, 272 (89%) IHR were effectively performed as one-day procedures. Upon multivariate analysis, predictive factors influencing practitioners for not propose an ambulatory care were increasing age (OR 0.97, P<0.001), body mass index (OR 0.95, P<0.001), ASA grade≥III (OR 0.23, P<0.001), hernia width≥4cm (OR 0.44, P<0.001), recurrent hernia (OR 0.55, P=0.01) and a laparoscopic IHR (OR 0.54, P<0.001). A number of patients (1157) were not selected preoperatively for outpatient IHR mainly because of organizational issues or an ASA grade≥III. Medical or social reasons were the main causes of failure of initially planned ambulatory settings. CONCLUSION Ambulatory IHR is a safe and feasible practice subject to a good preoperative selection of the patients. Increasing age, body mass index, ASA grade≥III, hernia width≥4cm, recurrent hernia and a laparoscopic IHR were identified to be preoperative factors for not proposing an ambulatory care. One-day surgery for IHR could be systematically proposed for IHR of small incisional hernias (<4cm) in young patients with few comorbidities.
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Saleh S, Plymale MA, Davenport DL, Roth JS. Risk-Assessment Score and Patient Optimization as Cost Predictors for Ventral Hernia Repair. J Am Coll Surg 2018; 226:540-546. [DOI: 10.1016/j.jamcollsurg.2017.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Discrepancies in the Definition of "Outpatient" Surgeries and Their Effect on Study Outcomes Related to ACDF and Lumbar Discectomy Procedures: A Retrospective Analysis of 45,204 Cases. Clin Spine Surg 2018; 31:E152-E159. [PMID: 29351096 DOI: 10.1097/bsd.0000000000000615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE To study the differences in definition of "inpatient" and "outpatient" [stated status vs. actual length of stay (LOS)], and the effect of defining populations based on the different definitions, for anterior cervical discectomy and fusion (ACDF) and lumbar discectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. SUMMARY OF BACKGROUND DATA There has been an overall trend toward performing ACDF and lumbar discectomy in the outpatient setting. However, with the possibility of patients who underwent outpatient surgery staying overnight or longer at the hospital under "observation" status, the distinction of "inpatient" and "outpatient" is not clear. MATERIALS AND METHODS Patients who underwent ACDF or lumbar discectomy in the 2005-2014 ACS-NSQIP database were identified. Outpatient procedures were defined in 1 of 2 ways: either as being termed "outpatient" or hospital LOS=0. Differences in definitions were studied. Further, to evaluate the effect of the different definitions, 30-day outcomes were compared between "inpatient" and "outpatient" and between LOS>0 and LOS=0 for ACDF patients. RESULTS Of the 4123 "outpatient" ACDF patients, 919 had LOS=0, whereas 3204 had LOS>0. Of the 13,210 "inpatient" ACDF patients, 337 had LOS=0, whereas 12,873 had LOS>0. Of the 15,166 "outpatient" lumbar discectomy patients, 8968 had LOS=0, whereas 6198 had LOS>0. Of the 12,705 "inpatient" lumbar discectomy patients, 814 had LOS=0, whereas 11,891 had LOS>0. On multivariate analysis of ACDF patients, when comparing "inpatient" with "outpatient" and "LOS>0" with "LOS=0" there were differences in risks for adverse outcomes based on the definition of outpatient status. CONCLUSIONS When evaluating the ACS-NSQIP population, ACDF and lumbar discectomy procedures recorded as "outpatient" can be misleading and often did not correlate with same day discharge. These findings have significant impact on the interpretation of existing studies and define an area that needs clarification for future studies. LEVEL OF EVIDENCE Level 3.
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Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias. Am J Surg 2018; 215:610-617. [PMID: 29402389 DOI: 10.1016/j.amjsurg.2018.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND After open complex ventral hernia repair (cVHR), chronic pain has a significant impact on quality of life and processes of care. METHODS Records of 177 patients undergoing cVHR were reviewed in order to characterize the burden of managing postoperative pain in the first post-operative year following open cVHR. RESULTS In this cohort, 91 patients initiated at least one unsolicited complaint of pain, though phone call (37), unscheduled clinic visit (45) or evaluation in the emergency room (9); among these an actionable diagnosis was found in 38 (41.8%). Among 41 patients who initiated additional unsolicited complaints of pain, an actionable diagnosis was found in only 3 patients. Risk factors for such complaints included pre-operative pain and the use of synthetic mesh. CONCLUSIONS Even in the absence of an actionable diagnosis, significant resources are utilized in evaluation and management of unsolicited complaints of pain in the first year after cVHR.
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Parker SG, Reid TH, Boulton R, Wood C, Sanders D, Windsor A. Proposal for a national triage system for the management of ventral hernias. Ann R Coll Surg Engl 2018; 100:106-110. [PMID: 28869388 PMCID: PMC5838688 DOI: 10.1308/rcsann.2017.0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 01/26/2023] Open
Abstract
Ventral hernia disease is becoming increasingly prevalent and complex. Subspecialisation for patients with challenging conditions requiring surgery has been shown to improve postoperative outcomes. Worldwide, there is an emergence of specialist hernia centres using new and innovative techniques to repair large and complicated ventral hernias. After a national meeting of hernia experts, we present an algorithm to be used as a national triage system for patients with ventral hernias, with the aim of ensuring that patients are operated on by the most appropriate surgeon. Evidence-based clinical risk factors and ventral hernia parameters are used for risk stratification and patient triage. We hope that this algorithm will guide future ventral hernia management in the UK.
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Affiliation(s)
- S G Parker
- Department of Colorectal Surgery and Abdominal Wall Reconstruction, University College London Hospital , London , UK
| | - T H Reid
- Department of Colorectal Surgery and Abdominal Wall Reconstruction, University College London Hospital , London , UK
| | - R Boulton
- Department of Colorectal Surgery and Abdominal Wall Reconstruction, University College London Hospital , London , UK
| | - C Wood
- Department of Colorectal Surgery and Abdominal Wall Reconstruction, University College London Hospital , London , UK
| | - D Sanders
- Department of Colorectal Surgery and Abdominal Wall Reconstruction, University College London Hospital , London , UK
| | - Ajc Windsor
- Department of Colorectal Surgery and Abdominal Wall Reconstruction, University College London Hospital , London , UK
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Bovonratwet P, Webb ML, Ondeck NT, Lukasiewicz AM, Cui JJ, McLynn RP, Grauer JN. Definitional Differences of 'Outpatient' Versus 'Inpatient' THA and TKA Can Affect Study Outcomes. Clin Orthop Relat Res 2017; 475:2917-2925. [PMID: 28083753 PMCID: PMC5670045 DOI: 10.1007/s11999-017-5236-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been great interest in performing outpatient THA and TKA. Studies have compared such procedures done as outpatients versus inpatients. However, stated "outpatient" status as defined by large national databases such as the National Surgical Quality Improvement Program (NSQIP) may not be a consistent entity, and the actual lengths of stay of those patients categorized as outpatients in NSQIP have not been specifically ascertained and may in fact include some patients who are "observed" for one or more nights. Current regulations in the United States allow these "observed" patients to stay more than one night at the hospital under observation status despite being coded as outpatients. Determining the degree to which this is the case, and what, exactly, "outpatient" means in the NSQIP, may influence the way clinicians read studies from that source and the way hospital systems and policymakers use those data. QUESTIONS/PURPOSES The purposes of this study were (1) to utilize the NSQIP database to characterize the differences in definition of "inpatient" and "outpatient" (stated status versus actual length of stay [LOS], measured in days) for THA and TKA; and (2) to study the effect of defining populations using different definitions. METHODS Patients who underwent THA and TKA in the 2005 to 2014 NSQIP database were identified. Outpatient procedures were defined as either hospital LOS = 0 days in NSQIP or being termed "outpatient" by the hospital. The actual hospital LOS of "outpatients" was characterized. "Outpatients" were considered to have stayed overnight if they had a LOS of 1 day or longer. The effects of the different definitions on 30-day outcomes were evaluated using multivariate analysis while controlling for potential confounding factors. RESULTS Of 72,651 patients undergoing THA, 529 were identified as "outpatients" but only 63 of these (12%) had a LOS = 0. Of 117,454 patients undergoing TKA, 890 were identified as "outpatients" but only 95 of these (11%) had a LOS = 0. After controlling for potential confounding factors such as gender, body mass index, functional status before surgery, comorbidities, and smoking status, we found "inpatient" THA to be associated with increased risk of any adverse event (relative risk, 2.643, p = 0.002), serious adverse event (relative risk, 2.455, p = 0.011), and readmission (relative risk, 2.775, p = 0.010) compared with "outpatient" THA. However, for the same procedure and controlling for the same factors, patients who had LOS > 0 were not associated with any increased risk compared with patients who had LOS = 0. A similar trend was also found in the TKA cohort. CONCLUSIONS Future THA, TKA, or other investigations on this topic should consistently quantify the term "outpatient" because different definitions, stated status or actual LOS, may lead to different assignments of risk factors for postoperative complications. Accurate data regarding risk factors for complications after total joint arthroplasty are crucial for efforts to reduce length of hospital stay and minimize complications. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Patawut Bovonratwet
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Matthew L. Webb
- 0000 0004 0435 0884grid.411115.1Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Nathaniel T. Ondeck
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Adam M. Lukasiewicz
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Jonathan J. Cui
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Ryan P. McLynn
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
| | - Jonathan N. Grauer
- 0000000419368710grid.47100.32Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520 USA
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The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study. Plast Reconstr Surg 2017; 139:1234-1244. [PMID: 28445378 DOI: 10.1097/prs.0000000000003264] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity and higher body mass index may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction. The authors hypothesized that higher body mass indexes result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in abdominal wall reconstruction patients. METHODS The authors included 511 consecutive patients who underwent abdominal wall reconstruction with underlay mesh. Patients were divided into three groups on the basis of preoperative body mass index: less than 30 kg/m (nonobese), 30 to 34.9 kg/m (class I obesity), and 35 kg/m or greater (class II/III obesity). The authors compared postoperative outcomes among these groups. RESULTS Class I and class II/III obesity patients had higher surgical-site occurrence rates than nonobese patients (26.4 percent versus 14.9 percent, p = 0.006; and 36.8 percent versus 14.9 percent, p < 0.001, respectively) and higher overall complication rates (37.9 percent versus 24.7 percent, p = 0.007; and 43.4 percent versus 24.7 percent, p < 0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3 percent versus 7.2 percent, p < 0.001; and 26.5 percent versus 7.2 percent, p < 0.001, respectively) and fat necrosis rates (10.0 percent versus 2.1 percent, p = 0.001; and 11.8 percent versus 2.1 percent, p < 0.001, respectively) than nonobese patients. Obesity class II/III patients had higher infection and seroma rates than nonobese patients (9.6 percent versus 4.3 percent, p = 0.041; and 8.1 percent versus 2.1 percent, p = 0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4 percent versus 7.7 percent, p = 0.204; and 10.3 percent versus 7.7 percent, p = 0.381, respectively) and freedom from hernia recurrence (overall log-rank, p = 0.41) similar to those of nonobese patients. CONCLUSION Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in abdominal wall reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Neupane R, Fayezizadeh M, Majumder A, Novitsky YW. Is old age a contraindication to elective ventral hernia repair? Surg Endosc 2017; 31:4425-4430. [PMID: 28342133 DOI: 10.1007/s00464-017-5492-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventral hernia repair (VHR) is a frequent problem in the expanding aging population. However, advanced age is often viewed as a contraindication to elective hernia surgery. We aimed to analyze outcomes of VHR in a large cohort of elderly patients. We hypothesized that elective VHR is safe and effective even in patients over 70 years old. METHODS We conducted a retrospective review of consecutive patients over the age of 70 who underwent VHR at a at a tertiary care hospital. Main outcome measures included postoperative complications and recurrence rate. RESULTS Between 2006 and 2015, 263 elderly patients who underwent elective VHR were included. Major comorbidities included diabetes, COPD, and smoking history. The majority of the patients underwent open repairs. Surgical site events occurred in 54 patients (21%). Postoperative complications included 17 venous thromboembolism occurrences, 2 myocardial infarctions, 41 patients who required postoperative critical care, and 1 mortality. Readmission within 90 days postoperatively occurred in 34 patients (13%). At a mean follow-up of 25.6 months, 17 patients in the open group and 6 patients in the laparoscopic group had a recurrence. CONCLUSION We demonstrated that VHR can be performed reasonably safely and effectively even in this potentially risky cohort. The use of laparoscopy might be associated with further reduction in morbidity. Overall, age should not be a contraindication to elective VHR, even in patients over 70 years old.
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Affiliation(s)
- Ruel Neupane
- Department of Surgery, Cleveland Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Mojtaba Fayezizadeh
- Department of Surgery, Cleveland Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Arnab Majumder
- Department of Surgery, Cleveland Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Yuri W Novitsky
- Department of Surgery, Cleveland Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Pernar LIM, Pernar CH, Dieffenbach BV, Brooks DC, Smink DS, Tavakkoli A. What is the BMI threshold for open ventral hernia repair? Surg Endosc 2016; 31:1311-1317. [DOI: 10.1007/s00464-016-5113-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/11/2016] [Indexed: 12/20/2022]
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