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Cutting through the fat: a retrospective analysis of clinical outcomes, cost, and quality of life with the addition of panniculectomy to ventral hernia repair in overweight patients

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Abstract

Background

Due to the increased prevalence of overweight patients with ventral hernia, abdominal wall reconstruction combining ventral hernia repair (VHR) with panniculectomy (VHR-PAN) in overweight patients is increasingly considered. We present a retrospective comparison between VHR-PAN and VHR alone in overweight patients by examining costs, clinical outcomes, and quality of life (QoL).

Methods

Patients with body mass index (BMI) > 25.0 kg/m2 underwent VHR-PAN or VHR alone between September 2015 and May 2017 with a single surgeon and were matched into cohorts by BMI and age (n = 24 in each cohort). QoL was assessed using the Hernia-related Quality of Life Survey (HerQLes). Cost was assessed using billing data. Statistical analyses were performed using Fisher’s exact tests, Mann–Whitney U tests, and regression modeling.

Results

Hernia defect size (p = 0.127), operative time (p = 0.140), mesh placement (p = 0.357), and recurrence rates (p = 0.156) did not vary significantly between cohorts at average follow up of one year. 60% of patients completed QoL surveys, with 61% net improvement in VHR-PAN postoperatively (p = 0.042) vs 36% in VHR alone (p = 0.054). Mean total hospitalization costs were higher for VHR alone (p = 0.019). Regression modeling showed no significant independent contribution of procedure performed due to differences in cost, wound complications, or hernia recurrence.

Conclusions

At mean follow up of 2 years, VHR-PAN patients reported a comparable increase in QoL to those who received VHR alone without significantly different cost and complication rates. Concurrent VHR-PAN may therefore be a safe approach for overweight patients presenting with hernia and excess abdominal skin.

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Abbreviations

VH:

Ventral hernia

QoL:

Quality of life

VHR:

Ventral hernia repair

VHR-PAN:

Ventral hernia repair with panniculectomy

BMI:

Body mass index

HerQLes:

Hernia-related quality of life survey

SSO:

Surgical site occurrence

SSI:

Surgical site infection

VHWG:

Ventral hernia working group

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Acknowledgements

The authors thank Jeffrey I. Rohrbach, MSN, of the Division of Data and Analytics at the University of Pennsylvania Health System for his assistance preparing and analyzing relevant cost data and Jesse Y. Hsu, PhD, of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania for his consultation on statistical methodology and design.

Funding

John P. Fischer is a paid consultant for Gore, Integra LifeSciences, Bard, and Allergan.

Author information

Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    C. E. Hutchison & J. A. Hernandez

  2. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    I. A. Rhemtulla, J. T. Mauch, R. B. Broach, F. A. Enriquez, C. A. Messa IV & J. P. Fischer

  3. Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA

    N. N. Williams & S. P. Harbison

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  1. C. E. Hutchison
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  4. R. B. Broach
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Correspondence to J. P. Fischer.

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Conflict of interest

John P. Fischer is a paid consultant for Gore, Integra LifeSciences, Bard, and Allergan. The remaining authors have no conflict of interest to disclose.

Ethical approval

This study was approved by the institutional review board, University of Pennsylvania, Philadelphia, PA, USA.

Human and animal rights

No experimental conditions were implemented in this retrospective review. No animals or human participants were directly involved in this study.

Informed consent

As this study was a retrospective review, patient informed consent was not required or obtained for this study. Data were fully anonymized to minimize risk of identification.

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Hutchison, C.E., Rhemtulla, I.A., Mauch, J.T. et al. Cutting through the fat: a retrospective analysis of clinical outcomes, cost, and quality of life with the addition of panniculectomy to ventral hernia repair in overweight patients. Hernia 23, 969–977 (2019). https://doi.org/10.1007/s10029-019-02024-5

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