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Association of body mass index with 30-day outcomes following groin hernia repair

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Abstract

Purpose

Although groin hernia repairs are relatively safe, efforts to identify factors associated with greater morbidity and resource utilization following these operations are warranted. An emphasis on obesity has limited studies from a comprehensive evaluation of the association between body mass index (BMI) and outcomes following groin hernia repair. Thus, we aimed to ascertain the association between BMI class with 30-day outcomes following these operations.

Methods

The 2014–2020 National Surgical Quality Improvement Program database was queried to identify adults undergoing non-recurrent groin hernia repair. Patient BMI was used to stratify patients into six groups: underweight, normal, overweight, and obesity classes I–III. Association of BMI with major adverse events (MAE), wound complication, and prolonged length of stay (pLOS) as well as 30-day readmission and reoperation were evaluated using multivariable regressions.

Results

Of the 163,373 adults who underwent groin hernia repair, the majority of patients were considered overweight (44.4%). Underweight patients more commonly underwent emergent operations and femoral hernia repair compared to others. After adjustment of intergoup differences, obesity class III was associated with greater odds of an MAE (AOR 1.50), wound complication (AOR 4.30), pLOS (AOR 1.40), and 30-day readmission (AOR 1.50) and reoperation (AOR 1.75, all p < 0.05). Underweight BMI portended greater odds of pLOS and unplanned readmission.

Conclusion

Consideration of BMI in patients requiring groin hernia repair could help inform perioperative expectations. Preoperative optimization and deployment of a minimally invasive approach when feasible may further reduce morbidity in patients at the extremes of the BMI spectrum.

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Authors and Affiliations

  1. Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA

    C. Lee, S. Ebrahimian, R. M. Mabeza, Z. Tran, J. Hadaya & P. Benharash

  2. Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA

    A. Moazzez

Authors
  1. C. Lee
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  2. S. Ebrahimian
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  3. R. M. Mabeza
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  4. Z. Tran
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  5. J. Hadaya
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  6. P. Benharash
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  7. A. Moazzez
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Corresponding author

Correspondence to C. Lee.

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Conflict of interest

The authors listed above do not have any conflict of interest to disclose.

Disclosures

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the sources of the data used herein; they have not been verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the author.

Informed consent

This was a retrospective study utilizing a national database with de-identified information across NSQIP participating centers, thus informed consent was not required.

Ethical approval

Due to the de-identified nature of the NSQIP registry, this study was deemed exempt from full review by the Institutional Review Board at the University of California, Los Angeles.

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Supplementary Information

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Supplemental Figure 1

Comparison of the absolute standardized mean differences between normal vs obesity class III (I), underweight vs obesity class III (II), and normal vs underweight (III) cohorts before (UW) and after weighting (W) of covariates. Supplementary file1 (TIF 481 KB)

Supplemental Table 1

Exclusion criteria ascertained using Current Procedural Terminology (CPT) and International Classification of Diseases, 9/10th revision (ICD-9/10) codes for repair of recurrent groin (inguinal and femoral) hernia, gangrenous and recurrent groin hernias. Supplementary file2 (DOCX 12 KB)

Supplemental Table 2

Complications categorized as grade III/IV by the Clavien-Dindo classification system were used to define major adverse event. Supplementary file3 (DOCX 13 KB)

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Lee, C., Ebrahimian, S., Mabeza, R.M. et al. Association of body mass index with 30-day outcomes following groin hernia repair. Hernia 27, 1095–1102 (2023). https://doi.org/10.1007/s10029-023-02773-4

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  • DOI: https://doi.org/10.1007/s10029-023-02773-4

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