John P Fischer1, Marten N Basta2, Jason D Wink2, Ari M Wes2, Stephen J Kovach2. 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. Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Panniculectomy (PAN) during ventral hernia repair (VHR) can be a challenging procedure associated with added risk. We utilized the ACS-NSQIP datasets to generate a risk model of morbidity following these combined interventions. METHODS: The 2005-2012 ACS-NSQIP databases were queried to identify all patients undergoing VHR-PAN. Multivariate logistic regression analyses were used to assess perioperative factors associated with surgical and medical morbidity. Internal validation was performed using bootstrap analysis and risk stratification was performed using weighted β-coefficients. RESULTS: 1974 patients underwent VHR-PAN with an average age of 53.6 ± 12.4 years and BMI of 36.4 ± 10.1 kg/m2. Surgical complications occurred in 23.8% of patients, whereas medical complications occurred in 11.5%. A multivariate logistic regression identified the presence of a renal comorbidity (OR = 1.62, P = 0.045), class II obesity (BMI = 34.9-40.0 kg/m2) (OR = 1.89, P < 0.001), class III obesity (BMI≥40 kg/m2) (OR = 2.66, P < 0.001), dirty/infected wound class (OR = 2.01, P = 0.003), smoking (OR = 1.41, P = 0.026), prolonged operative time (OR = 2.12, P = 0.001), and ASA physical status of ≥3 (OR = 1.69, P < 0.001) as independently associated with higher incidences of postoperative surgical complications. A multivariate regression analysis identified class II or III obesity (OR = 1.70, P = 0.003), contaminated or dirty/infected wounds (OR = 1.95, P < 0.001), diabetes (OR = 1.96, P = 0.001), pulmonary comorbidity (OR = 2.08, P = 0.005), and component separation (OR = 2.65, P < 0.001) as independently associated with higher incidences of postoperative medical complications. Simplified risk models of surgical and medical morbidity demonstrated good discrimination with C statistics of 0.69 and 0.70, respectively. CONCLUSIONS: We report a simple preoperative, internally-validated risk model of surgical and medical morbidity following VHR-PAN to guide patient selection. LEVEL OF EVIDENCE: Prognostic/risk category, level II.
BACKGROUND: Panniculectomy (PAN) during ventral hernia repair (VHR) can be a challenging procedure associated with added risk. We utilized the ACS-NSQIP datasets to generate a risk model of morbidity following these combined interventions. METHODS: The 2005-2012 ACS-NSQIP databases were queried to identify all patients undergoing VHR-PAN. Multivariate logistic regression analyses were used to assess perioperative factors associated with surgical and medical morbidity. Internal validation was performed using bootstrap analysis and risk stratification was performed using weighted β-coefficients. RESULTS: 1974 patients underwent VHR-PAN with an average age of 53.6 ± 12.4 years and BMI of 36.4 ± 10.1 kg/m2. Surgical complications occurred in 23.8% of patients, whereas medical complications occurred in 11.5%. A multivariate logistic regression identified the presence of a renal comorbidity (OR = 1.62, P = 0.045), class II obesity (BMI = 34.9-40.0 kg/m2) (OR = 1.89, P < 0.001), class III obesity (BMI≥40 kg/m2) (OR = 2.66, P < 0.001), dirty/infected wound class (OR = 2.01, P = 0.003), smoking (OR = 1.41, P = 0.026), prolonged operative time (OR = 2.12, P = 0.001), and ASA physical status of ≥3 (OR = 1.69, P < 0.001) as independently associated with higher incidences of postoperative surgical complications. A multivariate regression analysis identified class II or III obesity (OR = 1.70, P = 0.003), contaminated or dirty/infected wounds (OR = 1.95, P < 0.001), diabetes (OR = 1.96, P = 0.001), pulmonary comorbidity (OR = 2.08, P = 0.005), and component separation (OR = 2.65, P < 0.001) as independently associated with higher incidences of postoperative medical complications. Simplified risk models of surgical and medical morbidity demonstrated good discrimination with C statistics of 0.69 and 0.70, respectively. CONCLUSIONS: We report a simple preoperative, internally-validated risk model of surgical and medical morbidity following VHR-PAN to guide patient selection. LEVEL OF EVIDENCE: Prognostic/risk category, level II.
Authors: Julie L Holihan; Juan R Flores-Gonzalez; Jiandi Mo; Tien C Ko; Lillian S Kao; Mike K Liang Journal: World J Surg Date: 2017-05 Impact factor: 3.352
Authors: Sharbel A Elhage; Matthew N Marturano; Eva B Deerenberg; Jenny M Shao; Tanushree Prasad; Paul D Colavita; Kent W Kercher; B Todd Heniford; Vedra A Augenstein Journal: Surg Endosc Date: 2020-10-20 Impact factor: 4.584