Abstract
Background
To quantify the impact of body mass index (BMI) on surgical site infection (SSI) following abdominal wall reconstruction (AWR) using component separation techniques and attempt to identify obesity-related targets, such as BMI, that can be potentially used to guide preoperative patient optimization. Though AWR has established perioperative outcomes for hernia repair, the applicability in the obese population is not well established.
Methods
The 2005–2013 ACS-NSQIP participant use file was reviewed to compare SSI, severe, and overall morbidity in non-emergent AWR patients based on BMI. Multivariable logistic regression was used to control for patient demographics and comorbidities. Odds ratios (OR) with 95% confidence intervals were reported.
Results
We identified 4488 patients. The average BMI was 32.76 ± 7.70 kg/m2. The majority of cases (76.8%) had wound classified as clean. The SSI rate significantly increased at a BMI of ≥ 35 kg/m2 compared to < 35 (18.5% vs. 10.5%, p < 0.0001). There was no significant different in SSI rate between BMI 35–40 and > 40. After controlling for differences in baseline characteristics and wound classification, BMI ≥ 35 kg/m2 was independently associated with SSI (OR 1.47, 1.21–1.78), minor complications (OR 1.65, 1.41–1.94), major complications (OR 1.91, 1.60–2.27), re-operation (OR 1.59, 1.23–2.05), and hospital re-admission (OR 1.93, 1.23–3.02).
Conclusion
There is a significant increase in SSI and other perioperative complications in patients with a BMI ≥ 35 kg/m2 undergoing AWR. Higher BMI is also independently associated with higher resource utilization in this patient population. Severely obese patients in need of AWR may benefit from a structured preoperative weight loss intervention.
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References
Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183
Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EAM, Troidl H (2002) Randomized clinical trial of suture repair, polypropylene mesh or autoder-mal hernioplasty for incisional hernia. Br J Surg 89(1):50–56
de Vries Reilingh TS, van Goor H, Charbon JA, Rosman C, Hesselink EJ, van der Wilt GJ et al (2007) Repair of giant midline abdominal wall hernias: “Components Separation Technique” versus prosthetic repair. World J Surg 31(4):756–763
Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135
Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT (2005) Predictors of wound infection in ventral hernia repair. Am J Surg 190(5):676–681
den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438
Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EA, Troidl H (2002) Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 89(1):50–56
Soares KC, Baltodano PA, Hicks CW, Cooney CM, Olorundare IO, Cornell P, Burce K, Eckhauser FE (2015) Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis. Am J Surg 209(2):324–332.
Memon AA, Khan A, Zafar H et al (2013) Repair of large and giant incisional hernia with onlay mesh: perspective of a tertiary care hospital of a developing country. Int J Surg 11:41–45
Fry DE (2002) The economic costs of surgical site infection. Surg Infect 3(Suppl 1):S37–S43
Stremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M, Bergmann M (2010) Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 34(7):1702–1709
White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64(3):276–280
Poruk KE, Hicks CW, Magruder JT, Rodriguez-Unda N, Burce KK, Azoury SC, Cornell P, Cooney CM, Eckhauser FE (2017) Creation of a novel risk score for surgical site infection and occurrence after ventral hernia repair. Hernia 21:261–269
Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang M (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217(6):974–982
Rosen MJ, Aydogdu K, Grafmiller K, Petro CC, Faiman GH, Prabhu A (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19:1399–1406
Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8(1):42–46
Langer C, Schaper A, Liersch T et al (2005) Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia 9(1):16–21
Cheadle WG (2006) Risk factors for surgical site infection. Surg Infect 7(Suppl 1):S7–S11
Kaoutzanis C, Leichtle SW, Mouawad NJ et al (2015) Risk factors for postoperative wound infections and prolonged hos pitalization after ventral/incisional hernia repair. Hernia 19:113–123
Regner JL, Mrdutt MM, Munoz-Maldonado Y (2015) Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes. Am J Surg 210:1024–1029 (discussion 1029)
Spaniolas K, Trus TL, Adrales GL (2014) Ventral hernia repairs in the oldest-old: high-risk regardless of approach. Surg Endosc 28(4):1230–1237
Giordano SA, Garvey PB, Baumann DP, Liu J, Butler CE (2017) The impact of body mass index on abdominal wall reconstruction outcomes: a comparative study. Plast Reconstr Surg 139(5):1234–1244
Nelson JA, Fischer JP, Wink JD, Kovach SJ III (2014) A population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: can it be performed safely. J Plast Surg Hand Surg 48:305–311
Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264(2):226–232
Owei L, Swendiman RA, Kelz RR, Dempsey DT, Dumon KR (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surgery 162(6):1320–1329. https://doi.org/10.1016/j.surg.2017.07.025 (Epub 2017 Sep 28)
Rosen MJ (2017) Atlas of abdominal wall reconstruction. Elsevier
Newcomb WL, Polhill JL, Chen AY et al (2008) Staged hernia repair preceded by gastric bypass for the treatment of mor-bidly obese patients with complex ventral hernias. Hernia 12:465–469
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Dr. Docimo is a consultant for Boston Scientifict; Dr. Spaniolas reports non-financial support from Mallincktodt, grants from Merck, outside the submitted work; Dr. Aurora Pryor reports personal fees from Ethicon, personal fees from Medtronic, personal fees from Stryker, from Gore, grants from Baranova, grants from Obalon, outside the submitted work; Drs. Svestka, Bates, Sbayi, Schnur, and Talamini have no conflicts of interest or financial ties to disclose.
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Docimo, S., Spaniolas, K., Svestka, M. et al. Increased incidence of surgical site infection with a body mass index ≥ 35 kg/m2 following abdominal wall reconstruction with open component separation. Surg Endosc 33, 2503–2507 (2019). https://doi.org/10.1007/s00464-018-6538-9
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DOI: https://doi.org/10.1007/s00464-018-6538-9