M. Castillo-Angeles1, B. Okafor1, R. Wiener1, S. Moore1, S. Nitzschke1, R. Askari1 1Brigham And Women’s Hospital, Surgery, Boston, MA, USA
Introduction: Ventral hernia repair (VHR) is a relatively common procedure in the general population, and some form of immunosuppression can always be present. Prior research has shown conflicting results regarding outcomes after VHR in immunosuppressed patients, and little is known about these outcomes varying based on urgency of surgery. Our objective was to determine the impact of immunosuppression on mortality and morbidity following VHR stratified by elective/emergent status.
Methods: This was a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database from 2021-2022. We included all adults patients that underwent ventral hernia repair. Immunosupression was defined as regular administration of oral or parenteral corticosteroids or immunosuppressant medications within 30 days to the operative procedure. The primary outcomes were overall mortality, return to the OR, and readmissions within 30 days. Multivariate logistic regression was used to determine the association between immunosuppression and main outcomes.
Results: We included a total of 29,613 patients who underwent VHR, of which 27,034 were elective and 2,579 were emergent. 1,795 (6.64%) and 149 (5.78%) of patients undergoing elective and emergent VHR, respectively, received immunosuppressive therapy. In unadjusted analysis, within elective VHR, immunosuppressed patients were more likely to return to the OR (3.18 vs. 2.34%, p=0.026) and be readmitted (7.69 vs. 4.90%, p<0.001). Within emergent VHR, immunosuppressed patients were more likely to die (6.71 vs. 2.51%, p=0.002). After adjusting for clinical and demographic variables, immunosuppressive therapy was significantly associated with higher likelihood of readmission (OR 1.37, 95% CI 1.12 – 1.68) after elective VHR and higher mortality (OR 2.86, 95% CI 1.25 – 6.51) after emergent VHR.
Conclusion: Immunosuppression was significantly associated with worse outcomes after VHR, but this varied based on the urgency of the procedure (i.e. strong association with mortality only within patients who underwent emergent VHR). Our findings support the need for a more comprehensive preoperative evaluation followed by a tailored postoperative management in this population.