M. R. Arnold1, J. Otero1, K. A. Schlosser1, A. M. Kao1, T. Prasad1, A. Lincourt1, P. D. Colavita1, B. T. Heniford1 1Carolinas Medical Center,General Surgery,Charlotte, NC, USA
Introduction:
Components separation technique (CST), a complex surgical adjunct to ventral hernia repair (VHR), was originally described by Ramirez et al. greater than 25 years ago. Reports of CST have increased over the last several years, but no studies to date have examined the trends of CST utilization and associated complications over time. This purpose of this study is to examine the trends on CST over the past 10 years.
Methods:
The ACS-NSQIP database identified open VHR with components separation from 2005 to 2014. Preoperative risk factors, operative characteristics, outcomes, and morbidity trends were compared. Univariate analysis of outcomes and morbidity was performed. Multivariate analysis was performed to control for potential confounding variables.
Results:
A total of 129,532 patients underwent open VHR during the study period. CST was performed as part of 8,317 ventral hernia repairs. Use of CST increased from 39 cases in 2005, to 2,275 cases in 2014 (2.6% vs10.2%; p<0.0001). Over the past decade, preoperative smoking and dyspnea significantly decreased (p<0.05). A decrease was seen in superficial and deep wound infection (10.3% vs 5.7%;p<0.05) and (7.7% vs. 3.4%;p<0.05), and all wound related complications (18.0% vs 10.2%;p< 0.05), minor complications (18.0% vs. 13.4%; p<0.0001), and major complications (25.6% vs 12.8%;p<0.0001). Hospital length of stay decreased (11.0 vs. 6.3;p<0.05), and hospital readmissions decreased from 2011 to 2014 (14.4% vs. 11.1%;p<0.05). There was no significant change in thirty-day mortality (Range 0-1.42%;p=0.28). Multivariate regression was performed to control for pre-operative comorbidities; there was an overall decrease in wound dehiscence for 2011 (OR0.3, 95%CI 0.1-0.9), 2012 (OR0.2, 95%CI 0.1-0.7), 2013 (OR0.2, 95%CI 0.0-0.6), and 2014 (OR0.2, 95%CI 0.1-0.7). There was no significant change in major or minor complications, wound infection, or mortality.
Conclusion:
CST in VHR has significantly increased in frequency over 10 years. As experience with CST increased, there has been a significant decrease in the rate of associated complications. When adjusted for preoperative risk factors, the risk of wound dehiscence decreased. However, the rate of other complications has remained unchanged. This suggests preoperative patient optimization, and improvement in patient selection and modifiable risk factors, such as smoking, rather than changes in surgical technique, have led to improved outcomes. Due to the limitations of the NSQIP database, changes in chronic disease management, such as diabetes, may be overlooked. Additional studies are needed to further elucidate the reason for this decrease in complications.
