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Renshaw SM, Paredes AZ, Alzatari R, Huang LC, Phillips S, Poulose BK, Collins CE. Determining the Association Between Insurance Type and Myofascial Release in Large Ventral Hernias. J Surg Res 2024; 295:289-295. [PMID: 38056355 DOI: 10.1016/j.jss.2023.10.024] [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] [Received: 04/05/2023] [Revised: 09/14/2023] [Accepted: 10/28/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Abdominal wall reconstruction (AWR) utilizes advanced myofascial releases to perform complex ventral hernia repair (VHR). The relationship between the performance of AWR and disparities in insurance type is unknown. METHODS The Abdominal Core Health Quality Collaborative was queried for adults who had undergone an elective VHR between 2013 and 2020 with a hernia size ≥10 cm. Patients with missing insurance data were excluded. Comparison groups were divided by insurance type: favorable (private, Medicare, Veteran's Administration, Tricare) or unfavorable (Medicaid and self-pay). Propensity score matching compared the cumulative incidence of AWR between the favorable and unfavorable insurance comparison groups. RESULTS In total, 26,447 subjects met inclusion criteria. The majority (89%, n = 23,617) had favorable insurance, while (11%, n = 2830) had unfavorable insurance. After propensity score matching, 2821 patients with unfavorable insurance were matched to 7875 patients with favorable insurance. The rate of AWR with external oblique release or transversus abdominis release was significantly higher (23%, n = 655) among the unfavorable insurance group compared to those with favorable insurance (21%, n = 1651; P = 0.013). CONCLUSIONS This study provides evidence that patients with unfavorable insurance may undergo AWR with external oblique or transversus abdominis release at a greater rate than similar patients with favorable insurance. Understanding the mechanisms contributing to this difference and evaluating the financial implications of these trends represent important directions for future research in elective VHR.
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Affiliation(s)
- Savannah M Renshaw
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anghela Z Paredes
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ramez Alzatari
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Ohio University Heritage College of Osteopathic Medicine, Dublin Campus, Dublin, Ohio
| | - Sharon Phillips
- Ohio University Heritage College of Osteopathic Medicine, Dublin Campus, Dublin, Ohio
| | - Benjamin K Poulose
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Courtney E Collins
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Berger LE, Huffman SS, Bloomfield G, Marable JK, Spoer DL, Shan HD, Deldar R, Evans KK, Bhanot P, Alimi YR. Age is just a number: The role of advanced age in predicting complications following ventral hernia repair with component separation. Am J Surg 2024; 229:162-168. [PMID: 38182459 DOI: 10.1016/j.amjsurg.2023.12.032] [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] [Received: 08/31/2023] [Revised: 12/22/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND While advanced age is often considered a risk factor for complications following abdominal surgery, its impact on outcomes after complex open ventral hernia repair (VHR) with component separation technique (CST) remains unclear. METHODS A single-center retrospective review of patients who VHR with CST from November 2008 to January 2022 was performed and cohorts were stratified by presence of advanced age (≥60 years). RESULTS Of 219 patients who underwent VHR with CST, 114 patients (52.1 %) were aged ≥60 years. Multivariate analysis demonstrated BMI to be an independent predictor for any complication (OR 1.1, p = 0.002) and COPD was positively associated with seroma development (OR 20.1, p = 0.012). Advanced age did not independently predict postoperative outcomes, including hernia recurrence (OR 0.8, p = 0.766). CONCLUSIONS VHR with CST is generally safe to perform in patients of advanced age. Every patient's comorbidity profile should be thoroughly assessed preoperatively for risk stratification regardless of age.
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Affiliation(s)
- Lauren E Berger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA; Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, USA
| | - Samuel S Huffman
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA; Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Grace Bloomfield
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Julian K Marable
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Daisy L Spoer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA; Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Holly D Shan
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Romina Deldar
- Department of General Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Parag Bhanot
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA; Department of General Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Yewande R Alimi
- Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA; Department of General Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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Oliveira ESC, Calvi IP, Hora DAB, Gomes CP, Burlá MM, Mao RMD, de Figueiredo SMP, Lu R. Impact of sex on ventral hernia repair outcomes: A systematic review and meta-analysis. Am J Surg 2023; 226:385-392. [PMID: 37394348 DOI: 10.1016/j.amjsurg.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Given the variability in abdominal physiology and hernia presentation between sexes, better comprehension of sex-related differences in outcomes would tailor surgical approach and counseling regarding postoperative outcomes. This meta-analysis aims to appraise the effect of sex on the outcomes of ventral hernia repair. METHODS A literature search in PubMed, EMBASE and Cochrane selected studies comparing outcomes of ventral hernia repair between sexes. Postoperative outcomes were assessed by pooled and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS We screened 3128 studies, reviewed 133, and included 18 observational studies, which encompassed 220,799 patients following ventral hernia repair. Postoperative chronic pain was significantly higher in female (OR 1,9; 95% CI 1,64-2,2; p < 0,001). There were no significant differences in complications, readmission, or recurrence rates between females and males. CONCLUSION Female sex is associated with a higher risk of postoperative chronic pain following ventral hernia repair.
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Affiliation(s)
| | - Izabela P Calvi
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad Oblast, Russian Federation
| | - David A B Hora
- Division of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Cintia P Gomes
- Division of Obstetrics and Gynecology, Maimonides Medical Center, New York City, New York, United States
| | - Marina M Burlá
- Division of Medicine, Estácio de Sá Vista Carioca University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rui-Min Diana Mao
- Division of General Surgery, University of Texas Medical Branch, Galveston, TX, United States
| | | | - Richard Lu
- Division of General Surgery, University of Texas Medical Branch, Galveston, TX, United States
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Application of Component Separation and Short-Term Outcomes in Ventral Hernia Repairs. J Surg Res 2023; 282:1-8. [PMID: 36244222 DOI: 10.1016/j.jss.2022.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/10/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Component separation (CS) techniques have evolved in recent years. How surgeons apply the various CS techniques, anterior component separation (aCS) versus posterior component separation (pCS), by patient and hernia-specific factors remain unknown in the general population. Improving the quality of ventral hernia repair (VHR) on a large scale requires an understanding of current practice variations and how these variations ultimately affect patient care. In this study, we examine the application of CS techniques and the associated short-term outcomes while taking into consideration patient and hernia-specific factors. METHODS We retrospectively reviewed a clinically rich statewide hernia registry, the Michigan Surgical Quality Collaborative Hernia Registry, of persons older than 18 y who underwent VHR between January 2020 and July 2021. The exposure of interest was the use of CS. Our primary outcome was a composite end point of 30-d adverse events including any complication, emergency department visit, readmission, and reoperation. Our secondary outcome was surgical site infection (SSI). Multivariable logistic regression examined the association of CS use, 30-d adverse events, and SSI with patient-, hernia-, and operative-specific variables. We performed a sensitivity analysis evaluating for differences in application and outcomes of the posterior and aCS techniques. RESULTS A total of 1319 patients underwent VHR, with a median age (interquartile range) of 55 y (22), 641 (49%) female patients, and a median body mass index of 32 (9) kg/m2. CS was used in 138 (11%) patients, of which 101 (73%) were pCS and 37 (27%) were aCS. Compared to patients without CS, patients undergoing a CS had larger median hernia widths (2.5 cm (range 0.01-23 cm) versus 8 cm (1-30 cm), P < 0.001). Of the CS cases, 49 (36%) performed in hernias less than 6 cm in size. Following multivariate regression, factors independently associated with the use of a CS were diabetes (odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.19-3.36), previous hernia repair (OR: 1.88, 95% CI: 1.20-2.96), hernia width (OR: 1.28, 95% CI: 1.22-1.34), and an open approach (OR: 3.83, 95% CI: 2.24-6.53). Compared to patients not having a CS, use of a CS was associated with increased odds of 30-d adverse events (OR: 1.88 95% CI: 1.13-3.12) but was not associated with SSI (OR: 1.95, 95% CI: 0.74-4.63). Regression analysis demonstrated no differences in 30-d adverse events or SSI between the pCS and aCS techniques. CONCLUSIONS This is the first population-level report of patients undergoing VHR with concurrent posterior or aCS. These data suggest wide variation in the application of CS in VHR and raises a concern for potential overutilization in smaller hernias. Continued analysis of CS application and the associated outcomes, specifically recurrence, is necessary and underway.
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Quiroga-Centeno AC, Quiroga-Centeno CA, Guerrero-Macías S, Navas-Quintero O, Gómez-Ochoa SA. Systematic review and meta-analysis of risk factors for Mesh infection following Abdominal Wall Hernia Repair Surgery. Am J Surg 2021; 224:239-246. [PMID: 34969506 DOI: 10.1016/j.amjsurg.2021.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical Mesh Infection (SMI) after Abdominal Wall Hernia Repair (AWHR) represents a catastrophic complication. We performed a systematic review and meta-analysis to analyze the risk factors for SMI in the context of AWHR. METHODS PubMed, Embase, Scielo, and LILACS were searched without language or time restrictions from inception until June 2021. Articles evaluating the association between demographic, clinical, laboratory and surgical characteristics with SMI in AWHR were included. RESULTS 23 studies were evaluated, comprising a total of 118,790 patients (98% males; mean age 56.5 years) with a mesh infection pooled prevalence of 4%. Significant risk factors for SMI were type 2 diabetes mellitus, obesity, smoking history, steroids use, ASA III/IV, laparotomy vs laparoscopy, emergency surgery, duration of surgery and onlay mesh position vs sublay. The quality of evidence was regarded as very low-moderate. CONCLUSION Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.
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Affiliation(s)
| | | | | | | | - Sergio Alejandro Gómez-Ochoa
- Member Grupo de Investigación en Cirugía y Especialidades Quirúrgicas (GRICES-UIS), Universidad Industrial de Santander, Bucaramanga, Colombia; Research Division, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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