F. Gleason1, K. Feng1, S. Baker1, P. Washburn1, C. Perkins1, J. Richman1, M. Morris1, A. Parmar1 1University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction:
Post-operative outcomes of ventral hernia repairs (VHR) in obese and morbidly obese patients are poorly defined. To identify the association between obesity and postoperative outcomes, we reviewed our experience in this patient population. We hypothesized that postoperative morbidity and readmission would increase with increasing body mass index (BMI).
Methods:
We identified all patients undergoing elective VHR at our institution from 2012 to 2017 who were included in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Hernia specific characteristics were abstracted through chart review and patients with missing information were excluded. Hernia width was classified using European Hernia Society width classification: W1 (<4cm), W2 (4-10cm), and W3 (>10cm). Patients were stratified by BMI category based on the World Health Organization definitions of obesity: preobese (25-29.9), obese class I (30-34.9), obese class II (35-39.9), and obese class III (≥40). Surgical site occurrence (SSO) was defined as any surgical site infection or wound disruption. Descriptive statistics were calculated, and factors associated with SSO and readmissions in a bivariate analysis were included in a logistic regression model.
Results:
A total of 334 patients underwent elective VHR and had complete data on hernia characteristics. The mean age was 58.1 (+ 13.0), 57% (n=190) were female, 80.2% (n=268) were ASA class III, and 14.7% (n=49) were active smokers. Average BMI was 31.4 (range 17.8-55.5) and the majority of patients had a BMI<30 (47.9%), followed by 27.3% with a BMI 30-35, 13.8% BMI 35-40, and 11.1% with a BMI >40. Average hernia length was 8.6cm (0.4-45cm) and hernia widths were W1 (n=115, 34.4%), W2 (n=148, 44.3%), and W3 (n=71, 21.3%), and were similarly distributed across BMI categories. Operative approach included open (70.0%), laparoscopic (24.6%) and robotic (5.4%). Mesh was used in 62% of cases (71.4% intraperitoneal underlay, 5.5% preperitoneal underlay, 15.9% onlay, 0.3% unknown). The remaining repairs were component separation (27.0%) and primary suture repair (10.8%). Postoperative SSO occurred in 5.7% (n=19) of the cases, and the 30 day readmission rate was 7.2%. There was a trend towards increasing SSO by BMI groups and unplanned readmission, although these were not statistically significant. In a logistic regression model adjusting for hernia width, duration of operation, and patient smoking history, increasing BMI was only weakly associated with increased SSO (OR 1.081, CI 1.02-1.15) and unplanned readmission (OR 1.06, CI 1.01-1.12).
Conclusion:
We demonstrated that acceptable immediate post-surgical outcomes for elective ventral hernia repair are possible in a select population of older, obese patients with large hernia defects. While increasing BMI was associated with increased SSO and readmissions, these effects were relatively small.