L. Owei2, K. Dumon3, R. Kelz3, D. T. Dempsey3, N. Williams4 2University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 3University Of Pennsylvania,Department Of Surgery, Perelman School Of Medicine,Philadelphia, PA, USA 4University Of Pennsylvania,Division Of Surgical Education, Department Of Surgery, Perelman School Of Medicine,Philadelphia, PA, USA 1Hospital Of The University Of Pennsylvania,Philadelphia, PA, USA
Introduction:
Recent studies have been inconclusive about whether the degree of obesity is an independent risk factor for adverse outcomes following ventral hernia repair (VHR). This study aims to elucidate the influence of BMI class on complications in open VHR.
Methods:
A retrospective analysis was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2015. Univariate analyses, namely the Chi-square test for categorical variables and ANOVA for continuous variables, were used to examine the association between BMI class and patient characteristics, comorbidities, re-operation, and risk of perioperative complication. Logistic regression was also used to assess the risk of complication by BMI class with adjustment for potential confounders. All analyses included the entire cohort.
Results:
Of the 19,145 patients who underwent VHR between 2005 and 2015, 53.6% were obese. When stratified by BMI class, we found significant differences in age, gender, race, comorbidities (p < 0.001 for all). In the cohort, 65 patients (0.3%) lost > 10% of their body weight in the 6 months prior to surgery. The average operating time was 80.1 minutes. Higher BMI class was significantly associated with increased mean operating time (p < 0.001). Unplanned re-operation occurred in only 0.98% and eight patients died within 30 days of surgery; however, neither of these outcomes were significantly associated with BMI class. In contrast, all other complications (surgical, medical and respiratory) were significantly associated with BMI class (p < 0.0001). This association remained even after adjusting for age, sex, race and comorbidities. Patients with a BMI > or equal to 30 kg/m2 were found to be significantly more likely to have a complication compared to patients with BMIs < or equal to 25kg/m2 (Table 1). This risk of complications further increased with increasing BMI class.
Conclusion:
Being in a higher BMI class is a risk factor for surgical, medical and respiratory complications after VHR. Moreover, patients with BMIs > 40kg/m2 have 2.38 times greater risk for complications, with the odds ratio increasing with increasing BMI class. As only 0.3% of patients were able to lose > 10% of their body weight preoperatively, our findings suggest that bariatric surgery prior to VHR might be considered for patients with BMIs > 40kg/m2 to reduce their risk of complications.
