S. Scurci1, J. Parreco1, J. Buicko1, A. Rice1, R. Rattan3, R. Chandawarkar2 3University Of Miami,Trauma And Acute Care Surgery,Miami, FL, USA 1University Of Miami – Palm Beach Regional Campus,General Surgery,Miami, FL, USA 2Ohio State University,Plastic Surgery,Columbus, OH, USA
Introduction:
The optimal repair of large ventral hernias presents a challenge to surgeons and has not yet been elucidated. Component separation is one method commonly used to bring autologous tissue together at the midline without tension. Open component separation creates large subcutaneous dissection to produce large myocutaneous flaps which require division of perforator vessels which can produce flap necrosis, wound infections, and seromas. Theoretically, laparoscopic component separation aims to reduce these wound complications by avoiding an extensive dissection. Small, observational studies have compared outcomes after component separation, however no large nationwide studies have been published thus far. The purpose of this study was to compare outcomes after laparoscopic vs open component separation perform including nationwide readmission rates.
Methods:
The Nationwide Readmission Database for 2013-2014 was queried for all patients aged 18 years or older undergoing elective ventral hernia repair with component separation. Patients undergoing laparoscopic versus open repair were compared for the outcomes: length of stay (LOS) > 7 days, in-hospital mortality, readmission within 30 days, and readmission within 30 days to a different hospital. Univariable logistic regression was performed for these outcomes and the variables with p<0.05 were used for multivariable logistic regression. Results were weighted for national estimates
Results:
There were 6,867 patients who underwent ventral hernia repair with component separation during the study period. There were 158 (2.3%) patients undergoing laparoscopic repair. Multivariable logistic regression revealed that patients undergoing laparoscopic repair had a reduced risk for LOS > 7 days (OR 0.29, p<0.01) and readmission within 30 days (OR 0.41, p=0.01). However, there was no difference in mortality (p=0.27) and patients undergoing laparoscopic repair were at increased risk for readmission to a different hospital (OR 5.57, p=0.02) (Table 1).
Conclusion:
The laparoscopic approach to repair of ventral hernia with component separation is associated with improved outcomes including decreased readmission rates. However, readmissions after laparoscopic surgery are often to a different hospital and studies that miss these readmissions are at risk for underestimating readmission rates. The most common cause for readmission was wound complications. Laparoscopic component separation reduced readmissions and LOS, making it an ideal alternative to open component separation to reduce post-operative morbidity.
