Mary M Mrdutt1, Yolanda Munoz-Maldonado1, Justin L Regner2. 1. Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA. 2. Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA. Electronic address: Justin.Regner@BSWHealth.org.
Abstract
BACKGROUND: Anecdotally, obese patients experience increased morbidity with emergent ventral hernia repair (VHR). We hypothesized obese patients are over-represented in emergent VHRs and experience increased 30-day morbidity. METHODS: American College of Surgeons National Surgical Quality Improvement Program database (2011 to 2013) was queried for patients undergoing open VHR. Patients were stratified by body mass index (BMI) categories: underweight, normal weight, overweight, and obesity classes I, II, and III; 30-day postoperative complications (surgical site infections, return to operating room, dehiscence, death) were evaluated across BMI for elective vs emergent VHR. RESULTS: In all, 39,822 patients were included: 7.3% emergent. Obese classes I to III represented higher percent of emergent VHRs (55.8% vs 68.9%). Complication rate doubled for emergent group (7.2% vs 14.5%), and likelihood of at least one complication increased with BMI for emergent vs normal weight-elective VHR (overweight odds ratio, 2.2; 95% confidence interval, 1.4 to 3.4; class III odds ratio, 4.0; 95% confidence interval, 2.9 to 5.5). CONCLUSIONS: Selection bias exists with obese patients and ventral hernias. Emergent VHR have increased complications. Elective BMI cutoffs require re-evaluation. Copyright Â
BACKGROUND: Anecdotally, obesepatients experience increased morbidity with emergent ventral hernia repair (VHR). We hypothesized obesepatients are over-represented in emergent VHRs and experience increased 30-day morbidity. METHODS: American College of Surgeons National Surgical Quality Improvement Program database (2011 to 2013) was queried for patients undergoing open VHR. Patients were stratified by body mass index (BMI) categories: underweight, normal weight, overweight, and obesity classes I, II, and III; 30-day postoperative complications (surgical site infections, return to operating room, dehiscence, death) were evaluated across BMI for elective vs emergent VHR. RESULTS: In all, 39,822 patients were included: 7.3% emergent. Obese classes I to III represented higher percent of emergent VHRs (55.8% vs 68.9%). Complication rate doubled for emergent group (7.2% vs 14.5%), and likelihood of at least one complication increased with BMI for emergent vs normal weight-elective VHR (overweight odds ratio, 2.2; 95% confidence interval, 1.4 to 3.4; class III odds ratio, 4.0; 95% confidence interval, 2.9 to 5.5). CONCLUSIONS: Selection bias exists with obesepatients and ventral hernias. Emergent VHR have increased complications. Elective BMI cutoffs require re-evaluation. Copyright Â
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