L. Owei1, R. Swendiman1, S. Torres Landa1, D. Dempsey1, K. Dumon1 1Hospital Of The University Of Pennsylvania,Gastrointestinal Surgery,Philadelphia, PA, USA
Introduction:
A body mass index (BMI) greater than 30kg/m2 is a known independent risk factor for surgical and medical complications following open ventral hernia repair (VHR). This study aims to examine the relationship between BMI and laparoscopic VHR.
Methods:
Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2015. Patients were stratified into 7 BMI classes, as well as by hernia type (reducible vs. strangulated) and time of repair (initial vs. recurrent). Univariate analyses, namely the Chi-square test for categorical variables and ANOVA or Kruskal-Wallis for continuous variables, were employed to examine the association between BMI class and patient characteristics, comorbidities, recurrent hernia repair, strangulated hernias, and risk of perioperative complication. Logistic regression was used to assess the risk of complication by BMI class with adjustment for potential confounders.
Results:
Of the 57,957 patients who underwent laparoscopic VHR between 2005 and 2015, 61.4% were obese. Patients were stratified into 7 body mass index (BMI) classes: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5 – 24.9), overweight (25 – 29.9), obese (30 – 34.5), severely obese (35 – 39.9), morbidly obese (40 – 49.9), and super obese (BMI ≥ 50). When stratified by BMI class, we found significant differences in age, gender, race, comorbidities, and pre-operative characteristics. The overall complication rate was 4.0%, ranging from a low of 3.0% for normal BMI patients, to 6.9% for patients with a BMI ≥ 50 kg/m2. Recurrent repair and strangulated hernias both demonstrated higher complication rates. All complications (surgical and medical) were significantly associated with BMI class (p < 0.0001). This association remained even after adjusting for age, sex, race, comorbidities, recurrent repair, and strangulated hernias. Patients with a BMI ≥ 40 kg/m2 were found to be significantly more likely to have a complication compared to patients with BMIs ≤ 25kg/m2 (Table 1). This risk of complications further increased with increasing BMI class.
Conclusion:
Obesity, especially those in a higher BMI class, is an independent risk factor for surgical and medical complications after laparoscopic VHR. Patients with BMIs ≥ 40kg/m2 are at 1.3 times greater risk for complications. While this group is different from the patients undergoing open VHR, the higher threshold at which BMI becomes a significant risk factor in laparoscopic VHR suggests that a laparoscopic approach should be considered for patients with BMIs ≥ 30kg/m2 to reduce their risk of post-operative complications.
