John P Fischer1, Charles T Tuggle2, Ari M Wes3, Stephen J Kovach3. 1. Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: John.Fischer2@uphs.upenn.edu. 2. Section of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA. 3. Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Recent studies have assessed the risks and benefits of performing concurrent panniculectomy (PAN) in the setting of hernia repair, gynecologic surgery, and oncologic resections with conflicting results. The aim of this study is to assess the added risk of ventral hernia repair and panniculectomy (VHR-PAN) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data sets. METHODS: The 2005-2011 ACS-NSQIP databases were queried to identify all patients undergoing VHR alone or VHR-PAN. Propensity scores were used to account for potential selection bias given the non-randomized assignment of concurrent panniculectomy and the retrospective nature of this study. Multivariate logistic regression analyses were used to assess the impact of concurrent PAN on complications. RESULTS: A total of 55,537 patients were identified. Propensity matching yielded two groups of patients: VHR (n = 1250) and VHR-PAN (n = 1250). Few statistically significant differences existed between matched cohorts. Overall, wound complications (P < 0.001), venous thromboembolism (P = 0.044), incidence of reoperation (P < 0.001), and medical morbidity (P < 0.001) were significantly higher in the VHR-PAN group. In an adjusted, fixed-effects analysis, concurrent panniculectomy was associated with wound healing complications (OR = 1.69, P < 0.001), increased incidence of unplanned reoperations (OR = 2.08, P ≤ 0.001), venous thromboembolism (OR = 2.48, P = 0.043), and overall medical morbidity (OR = 2.08, P < 0.001). Sub-group analysis of wound complications demonstrated that superficial surgical site infections occurred significantly more often in concurrent cases (P = 0.018). CONCLUSIONS: This analysis quantifies the added risk of performing a panniculectomy concurrent with ventral hernia repair, demonstrating higher incidence of wound complications (superficial infections), unplanned reoperations, and VTE. LEVEL OF EVIDENCE: Prognostic/risk category, level II.
BACKGROUND: Recent studies have assessed the risks and benefits of performing concurrent panniculectomy (PAN) in the setting of hernia repair, gynecologic surgery, and oncologic resections with conflicting results. The aim of this study is to assess the added risk of ventral hernia repair and panniculectomy (VHR-PAN) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data sets. METHODS: The 2005-2011 ACS-NSQIP databases were queried to identify all patients undergoing VHR alone or VHR-PAN. Propensity scores were used to account for potential selection bias given the non-randomized assignment of concurrent panniculectomy and the retrospective nature of this study. Multivariate logistic regression analyses were used to assess the impact of concurrent PAN on complications. RESULTS: A total of 55,537 patients were identified. Propensity matching yielded two groups of patients: VHR (n = 1250) and VHR-PAN (n = 1250). Few statistically significant differences existed between matched cohorts. Overall, wound complications (P < 0.001), venous thromboembolism (P = 0.044), incidence of reoperation (P < 0.001), and medical morbidity (P < 0.001) were significantly higher in the VHR-PAN group. In an adjusted, fixed-effects analysis, concurrent panniculectomy was associated with wound healing complications (OR = 1.69, P < 0.001), increased incidence of unplanned reoperations (OR = 2.08, P ≤ 0.001), venous thromboembolism (OR = 2.48, P = 0.043), and overall medical morbidity (OR = 2.08, P < 0.001). Sub-group analysis of wound complications demonstrated that superficial surgical site infections occurred significantly more often in concurrent cases (P = 0.018). CONCLUSIONS: This analysis quantifies the added risk of performing a panniculectomy concurrent with ventral hernia repair, demonstrating higher incidence of wound complications (superficial infections), unplanned reoperations, and VTE. LEVEL OF EVIDENCE: Prognostic/risk category, level II.
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