OBJECTIVE: The aim of this study was to determine whether preoperative nutritional counseling and exercise (prehabilitation) in obese patients with ventral hernia repair (VHR) results in more hernia-free and complication-free patients. BACKGROUND: Obesity and poor fitness are associated with complications following VHR. These issues are prevalent in low socioeconomic status patients. METHODS: This was a blinded, randomized controlled trial at a safety-net academic institution. Obese patients (BMI 30 to 40) seeking VHR were randomized to prehabilitation versus standard counseling. VHR was performed once preoperative requirements were met: 7% total body weight loss or 6 months of counseling and no weight gain. Primary outcome was the proportion of hernia-free and complication-free patients. Secondary outcomes were wound complications at 1 month postoperative and weight loss measures. Univariate analysis was performed. RESULTS: Among 118 randomized patients, prehabilitation was associated with a higher percentage of patients who lost weight and achieved weight loss goals; however, prehabilitation was also associated with a higher dropout rate and need for emergent repair. VHR was performed in 44 prehabilitation and 34 standard counseling patients. There was a trend toward less wound complication in prehabilitation patients (6.8% vs 17.6%, P = 0.167). The prehabilitation group was more likely to be hernia-free and complication-free (69.5% vs 47.5%, P = 0.015). CONCLUSIONS: It is feasible to implement a prehabilitation program for obese patients at a safety-net hospital. Prehabilitation patients have a higher likelihood of being hernia-free and complication-free postoperatively. Although further trials and long-term outcomes are needed, prehabilitation may benefit obese surgical patients, but there may be increased risks of dropout and emergent repair. CLINICAL TRIAL REGISTRATION: This trial was registered with clinicaltrials.gov (NCT02365194).
RCT Entities:
OBJECTIVE: The aim of this study was to determine whether preoperative nutritional counseling and exercise (prehabilitation) in obesepatients with ventral hernia repair (VHR) results in more hernia-free and complication-free patients. BACKGROUND: Obesity and poor fitness are associated with complications following VHR. These issues are prevalent in low socioeconomic status patients. METHODS: This was a blinded, randomized controlled trial at a safety-net academic institution. Obesepatients (BMI 30 to 40) seeking VHR were randomized to prehabilitation versus standard counseling. VHR was performed once preoperative requirements were met: 7% total body weight loss or 6 months of counseling and no weight gain. Primary outcome was the proportion of hernia-free and complication-free patients. Secondary outcomes were wound complications at 1 month postoperative and weight loss measures. Univariate analysis was performed. RESULTS: Among 118 randomized patients, prehabilitation was associated with a higher percentage of patients who lost weight and achieved weight loss goals; however, prehabilitation was also associated with a higher dropout rate and need for emergent repair. VHR was performed in 44 prehabilitation and 34 standard counseling patients. There was a trend toward less wound complication in prehabilitation patients (6.8% vs 17.6%, P = 0.167). The prehabilitation group was more likely to be hernia-free and complication-free (69.5% vs 47.5%, P = 0.015). CONCLUSIONS: It is feasible to implement a prehabilitation program for obesepatients at a safety-net hospital. Prehabilitation patients have a higher likelihood of being hernia-free and complication-free postoperatively. Although further trials and long-term outcomes are needed, prehabilitation may benefit obese surgical patients, but there may be increased risks of dropout and emergent repair. CLINICAL TRIAL REGISTRATION: This trial was registered with clinicaltrials.gov (NCT02365194).
Authors: Esmaeel R Dadashzadeh; Lauren V Huckaby; Robert Handzel; M Shanaz Hossain; Gloria D Sanin; Vincent P Anto; Patrick Bou-Samra; J B Moses; Stephen Cai; Heather M Phelos; Richard L Simmons; Matthew R Rosengart; Dirk J van der Windt Journal: Ann Surg Date: 2022-02-01 Impact factor: 12.969
Authors: Michael Katzen; Sullivan A Ayuso; Jana Sacco; Dau Ku; Gregory T Scarola; Kent W Kercher; Paul D Colavita; Vedra A Augenstein; B Todd Heniford Journal: Surg Endosc Date: 2022-08-04 Impact factor: 3.453
Authors: A J Rios-Diaz; M P Morris; A N Christopher; V Patel; R B Broach; B T Heniford; J Y Hsu; J P Fischer Journal: Hernia Date: 2022-08-25 Impact factor: 2.920
Authors: S M Maskal; A M Boyd-Tressler; L J Heinberg; K C Montelione; C C Petro; D M Krpata; M J Rosen; A S Prabhu Journal: Hernia Date: 2022-06-08 Impact factor: 2.920