Skip to main content

Advertisement

SpringerLink
Log in

Does smoking influence the clinical outcomes of robotic ventral hernia repair? A propensity score matching analysis study

  • Research
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

The purpose of this study is to compare the clinical outcomes of robotic ventral hernia repair (RVHR) between smokers and non-smokers. Data for patients undergoing RVHR between 2012 and 2022 were collected. Patients were assigned to either smoking (+) or smoking (−) groups, according to their smoking status in the last 3 months prior to their procedure. Pre-, intra- and postoperative variables including surgical site occurrences (SSO) and infections (SSI), and hernia recurrence were analyzed after a propensity score matching analysis based on the patients’ demographics and hernia’s characteristics. Each group consisted of 143 patients matched according to their preoperative characteristics. There were no differences in terms of demographics and hernia characteristics. Intraoperative complications occurred at a comparable rate between both groups (p = 0.498). Comprehensive Complication Index® and all complication grades of the Clavien–Dindo classification were similar between both groups. Surgical site occurrences and infections did not differ either [smoking (+) vs. smoking (−): 7.6% vs 5.4%, p = 0.472; 5 vs. 0, p = 0.060, respectively). Rates of SSOs and SSIs that required any intervention (SSOPI) were similar in both groups [smoking (+): 3.1% vs. smoking (−): 0.8%, p = 0.370]. With a mean follow-up of 50 months for the cohort, recurrences rates were also comparable with 7 recorded in the smoking (−) versus 5 in the smoking (+) group (p = 0.215). Our study showed comparable rates of SSOs, SSIs, SSOPIs, and recurrence between smokers and non-smokers following RVHR. Future studies should compare the open, laparoscopic, and robotic approaches in smokers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Bittner JGT, Alrefai S, Vy M, Mabe M, Del Prado PAR, Clingempeel NL (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32(2):727–734. https://doi.org/10.1007/s00464-017-5729-0

    Article  PubMed  Google Scholar 

  2. Bracale U, Corcione F, Neola D, Castiglioni S, Cavallaro G, Stabilini C, Botteri E, Sodo M, Imperatore N, Peltrini R (2021) Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis. Hernia 25(6):1471–1480. https://doi.org/10.1007/s10029-021-02487-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kanters AE, Krpata DM, Blatnik JA, Novitsky YM, Rosen MJ (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215(6):787–793. https://doi.org/10.1016/j.jamcollsurg.2012.08.012

    Article  PubMed  Google Scholar 

  4. Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. https://doi.org/10.1016/j.surg.2010.01.008

    Article  PubMed  Google Scholar 

  5. Parker SG, Mallett S, Quinn L, Wood CPJ, Boulton RW, Jamshaid S, Erotocritou M, Gowda S, Collier W, Plumb AAO, Windsor ACJ, Archer L, Halligan S (2021) Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis. BJS Open. https://doi.org/10.1093/bjsopen/zraa071

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dietz UA, Kudsi OY, Gokcal F, Bou-Ayash N, Pfefferkorn U, Rudofsky G, Baur J, Wiegering A (2021) Excess body weight and abdominal hernia. Visc Med 37(4):246–253. https://doi.org/10.1159/000516047

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gokcal F, Morrison S, Kudsi OY (2020) Robotic ventral hernia repair in octogenarians: perioperative and long-term outcomes. J Robot Surg 14(2):275–281. https://doi.org/10.1007/s11701-019-00979-2

    Article  PubMed  Google Scholar 

  8. Ekmann JR, Christoffersen MW, Jensen KK (2022) Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation? Hernia 26(5):1315–1323. https://doi.org/10.1007/s10029-022-02663-1

    Article  CAS  PubMed  Google Scholar 

  9. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative ftS (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies STROBE statement. Ann Intern Med 147(8):573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010

    Article  Google Scholar 

  10. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gokcal F, Morrison S, Kudsi OY (2019) Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair. Hernia. https://doi.org/10.1007/s10029-019-01946-4

    Article  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  13. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258(1):1–7. https://doi.org/10.1097/SLA.0b013e318296c732

    Article  PubMed  Google Scholar 

  14. Petro CC, Novitsky YW (2016) Classification of hernias. Hernia surgery. Springer, Berlin, pp 15–21

    Chapter  Google Scholar 

  15. Thoemmes F (2012) Propensity score matching in SPSS. pdf. edn. University of Tubingen, Tubingen

    Google Scholar 

  16. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191

    Article  PubMed  Google Scholar 

  17. Hansen BB, Bowers J (2008) Covariate balance in simple, stratified and clustered comparative studies. J Qual Control 23(2):219–236. https://doi.org/10.1214/08-STS254

    Article  Google Scholar 

  18. Iacus S, King G, Porro G (2009) cem: software for coarsened exact matching. J Stat Softw 30(i09):1–27

    Google Scholar 

  19. Huerta S, Varshney A, Patel PM, Mayo HG, Livingston EH (2016) Biological mesh implants for abdominal hernia repair: US Food and Drug Administration approval process and systematic review of its efficacy. JAMA Surg 151(4):374–381. https://doi.org/10.1001/jamasurg.2015.5234

    Article  PubMed  Google Scholar 

  20. Tubre DJ, Schroeder AD, Estes J, Eisenga J, Fitzgibbons RJ Jr (2018) Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction. Hernia 22(6):1003–1013. https://doi.org/10.1007/s10029-018-1826-9

    Article  CAS  PubMed  Google Scholar 

  21. Cheadle WG (2006) Risk factors for surgical site infection. Surg Infect (Larchmt) 7(Suppl 1):S7-11. https://doi.org/10.1089/sur.2006.7.s1-7

    Article  PubMed  Google Scholar 

  22. Dai X, Gakidou E, Lopez AD (2022) Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control 31(2):129–137. https://doi.org/10.1136/tobaccocontrol-2021-056535

    Article  PubMed  Google Scholar 

  23. Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204(6):1178–1187. https://doi.org/10.1016/j.jamcollsurg.2007.03.022

    Article  PubMed  Google Scholar 

  24. Sørensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jørgensen LN (2005) Smoking is a risk factor for incisional hernia. Arch Surg 140(2):119–123. https://doi.org/10.1001/archsurg.140.2.119

    Article  PubMed  Google Scholar 

  25. Sørensen LT, Hemmingsen U, Kallehave F, Wille-Jørgensen P, Kjaergaard J, Møller LN, Jørgensen T (2005) Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 241(4):654–658. https://doi.org/10.1097/01.sla.0000157131.84130.12

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chapple IL, Matthews JB (2007) The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontol 2000 43:160–232. https://doi.org/10.1111/j.1600-0757.2006.00178.x

    Article  PubMed  Google Scholar 

  27. Gustafsson A, Asman B, Bergström K (2000) Cigarette smoking as an aggravating factor in inflammatory tissue-destructive diseases. Increase in tumor necrosis factor-alpha priming of peripheral neutrophils measured as generation of oxygen radicals. Int J Clin Lab Res 30(4):187–190. https://doi.org/10.1007/s005990070005

    Article  CAS  PubMed  Google Scholar 

  28. Sørensen LT (2012) Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 255(6):1069–1079. https://doi.org/10.1097/SLA.0b013e31824f632d

    Article  PubMed  Google Scholar 

  29. Park H, de Virgilio C, Kim DY, Shover AL, Moazzez A (2021) Effects of smoking and different BMI cutoff points on surgical site infection after elective open ventral hernia repair. Hernia 25(2):337–343. https://doi.org/10.1007/s10029-020-02190-x

    Article  CAS  PubMed  Google Scholar 

  30. Kubasiak JC, Landin M, Schimpke S, Poirier J, Myers JA, Millikan KW, Luu MB (2017) The effect of tobacco use on outcomes of laparoscopic and open ventral hernia repairs: a review of the NSQIP dataset. Surg Endosc 31(6):2661–2666. https://doi.org/10.1007/s00464-016-5280-4

    Article  PubMed  Google Scholar 

  31. Borad NP, Merchant AM (2017) The effect of smoking on surgical outcomes in ventral hernia repair: a propensity score matched analysis of the National Surgical Quality Improvement Program data. Hernia 21(6):855–867. https://doi.org/10.1007/s10029-017-1664-1

    Article  CAS  PubMed  Google Scholar 

  32. Soppe S, Slieker S, Keerl A, Muller MK, Wirsching A, Nocito A (2022) Emergency repair and smoking predict recurrence in a large cohort of ventral hernia patients. Hernia 26(5):1337–1345. https://doi.org/10.1007/s10029-022-02672-0

    Article  CAS  PubMed  Google Scholar 

  33. Dietz UA, Winkler MS, Härtel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich C, Heuschmann P, Germer CT (2014) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 18(1):19–30. https://doi.org/10.1007/s10029-012-0999-x

    Article  CAS  PubMed  Google Scholar 

  34. Petro CC, Haskins IN, Tastaldi L, Tu C, Krpata DM, Rosen MJ, Prabhu AS (2019) Does active smoking really matter before ventral hernia repair? An AHSQC analysis. Surgery 165(2):406–411. https://doi.org/10.1016/j.surg.2018.07.039

    Article  PubMed  Google Scholar 

  35. Kudsi OY, Gokcal F, Bou-Ayash N, Crawford AS, Chang K, Chudner A, La Grange S (2022) Robotic ventral hernia repair: lessons learned from a 7-year experience. Ann Surg 275(1):9–16. https://doi.org/10.1097/sla.0000000000004964

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA

    Omar Yusef Kudsi, Georges Kaoukabani & Fahri Gokcal

  2. Tufts University School of Medicine, Boston, MA, USA

    Omar Yusef Kudsi

  3. Tufts Medical Center, Boston, MA, USA

    Naseem Bou-Ayash

Authors
  1. Omar Yusef Kudsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georges Kaoukabani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naseem Bou-Ayash
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fahri Gokcal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. GK and Dr. FG. The first draft of the manuscript was written by Dr. GK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Omar Yusef Kudsi.

Ethics declarations

Conflict of interest

Drs. Kaoukabani, Bou-Ayash, and Gokcal have no conflicts of interest or financial ties to disclose. Dr. Kudsi has received a teaching course and/or consultancy fees from Intuitive Surgical and W.L. Gore outside the submitted work.

Ethical approval

This study was approved by the IRB.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kudsi, O.Y., Kaoukabani, G., Bou-Ayash, N. et al. Does smoking influence the clinical outcomes of robotic ventral hernia repair? A propensity score matching analysis study. J Robotic Surg 17, 2229–2236 (2023). https://doi.org/10.1007/s11701-023-01645-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-023-01645-4

Keywords

Search

Navigation