G. Hoeltzel1, S. Badenhausen1, L. Owei1, K. Dumon1, R. Swendiman1 1Hospital Of The University Of Pennsylvania,Department Of General And Bariatric Surgery,Philadelphia, PA, USA
Introduction:
Past reports show that the likelihood for developing a hernia increases by 10% for every one unit increase in body mass index (BMI). Given the dramatic and well-established associations between obesity, wound complications, and risk for hernia recurrence, patients with obesity presenting for inguinal hernia repair (IHR) represent a growing challenge for surgeons. The aim of this study was to evaluate the association between BMI and 30-day outcomes following IHR.
Methods:
We performed a retrospective cohort study of patients who underwent laparoscopic or open IHR using the ACS-NSQIP database (2007-2017). Patients were stratified into 7 BMI groups (< 18.5, 18.5 – 24.9, 25.0 – 29.9, 30.0 – 34.9, 35 – 39.9, 40-49.9, and ≥ 50.0 kg/m2) according to the World Health Organization classification system. Multivariate logistic regression models were used to assess the differences in associations between BMI and mortality, reoperation, and readmission among patients with initial or recurrent inguinal hernias, as well as those with reducible or strangulated pathology.
Results:
The mean age of the 250,520 patients who met inclusion criteria was 57.9 years. Only 8.5% of patients were female, and open surgery was the approach of choice in 71% of IHR cases. For reducible IHR, underweight BMI (<18.5 kg/m2) was associated with increased risk of 30-day mortality (OR=2.6, p=0.004) and complications (OR =1.5, p<0.001). Reducible IHR was associated with a greater risk for complications in patients with BMI 30-34.9 (OR=1.2, p<0.008), BMI 35-39.9 (OR= 1.7, p<0.001), and 40-49.9 (OR=1.5, p<0.001) compared to those of normal weight. However, there was no association observed between obesity and risk for mortality following reducible IHR. In strangulated IHR patients, there were no associations observed between BMI class and risk for mortality, reoperation, or complication. Recurrent hernias were associated with a higher risk of reoperation in both reducible (OR=1.4, p<0.001) and strangulated (OR=1.4, p=0.006) IHR patients.
Conclusion:
Underweight patients are at greater risk for death and complications after 30 days compared to normal weight patients in the setting of reducible, but not strangulated, IHR. Increasing BMI class was not associated with a greater likelihood for complications, reoperations, or mortality in patients with strangulated IH pathology.
