S Said1, J Thomas2, K Montelione3, A Fafaj3, L Beffa3, D Krpata3, A Prabhu3, M Rosen3, C Petro3. 1. Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA. saids@ccf.org. 2. Department of General Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA. 3. Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.
Abstract
PURPOSE: With the advancement of abdominal wall reconstruction, more complex hernia patients are undergoing repairs that may require a postoperative surgical intensive care unit (SICU) admission. The volume ratio (VR) of the hernia sac to the abdominal cavity is an easily applied method to quantify disease severity and the ensuing physiologic insult. This study aimed to predict postoperative SICU admission using VR and other preoperative variables. METHODS: A single-center retrospective review was conducted for patients undergoing large abdominal hernias (width ≥ 18 cm) repaired from September 2014 to October 2019. Patient demographics, comorbidities, abdominal surgical history, and VR were analyzed through univariate and multivariable methods to identify predictors of SICU admission within the first two postoperative days. A predictive model was generated and validated. RESULTS: Of 434 patients meeting inclusion criteria, 127(29%) required a SICU admission within the first two postoperative days. VR was significantly higher in SICU patients (Median 30.6% [IQR 14.4-59.0] vs. 10.6% [IQR 4.35-23.6], P < 0.001). Male sex, history of chronic obstructive pulmonary disease, prior component separation, recurrent incisional hernia, hernia grade 3, and VR showed higher odds of SICU admission. When validated on a testing dataset, these variables showed strong SICU admission predictions, with an area under the curve, sensitivity, and specificity of 0.82, 81.7% and 68.5%, respectively. CONCLUSIONS: The volume ratio in combination with preoperatively available variables can reliably predict postoperative SICU admission following abdominal wall reconstruction. Anticipating such events preoperatively allows for bed space allocation as well as optimizing postoperative care.
PURPOSE: With the advancement of abdominal wall reconstruction, more complex hernia patients are undergoing repairs that may require a postoperative surgical intensive care unit (SICU) admission. The volume ratio (VR) of the hernia sac to the abdominal cavity is an easily applied method to quantify disease severity and the ensuing physiologic insult. This study aimed to predict postoperative SICU admission using VR and other preoperative variables. METHODS: A single-center retrospective review was conducted for patients undergoing large abdominal hernias (width ≥ 18 cm) repaired from September 2014 to October 2019. Patient demographics, comorbidities, abdominal surgical history, and VR were analyzed through univariate and multivariable methods to identify predictors of SICU admission within the first two postoperative days. A predictive model was generated and validated. RESULTS: Of 434 patients meeting inclusion criteria, 127(29%) required a SICU admission within the first two postoperative days. VR was significantly higher in SICU patients (Median 30.6% [IQR 14.4-59.0] vs. 10.6% [IQR 4.35-23.6], P < 0.001). Male sex, history of chronic obstructive pulmonary disease, prior component separation, recurrent incisional hernia, hernia grade 3, and VR showed higher odds of SICU admission. When validated on a testing dataset, these variables showed strong SICU admission predictions, with an area under the curve, sensitivity, and specificity of 0.82, 81.7% and 68.5%, respectively. CONCLUSIONS: The volume ratio in combination with preoperatively available variables can reliably predict postoperative SICU admission following abdominal wall reconstruction. Anticipating such events preoperatively allows for bed space allocation as well as optimizing postoperative care.
Authors: Gregory W Kirschen; Maria S Altieri; Suresh Yelika; Andrew T Bates; Jessica Schnur; Salvatore Docimo; Konstantinos Spaniolas; Chencan Zhu; Jie Yang; Mark Talamini; Aurora D Pryor; Samer Sbayi Journal: Surg Endosc Date: 2019-08-09 Impact factor: 4.584
Authors: Konstantin M Gaidukov; Elena N Raibuzhis; Ayyaz Hussain; Alexey Y Teterin; Alexey A Smetkin; Vsevolod V Kuzkov; Manu Lng Malbrain; Mikhail Y Kirov Journal: World J Crit Care Med Date: 2013-05-04
Authors: J D Thomas; A Fafaj; S J Zolin; R Naples; C M Horne; C C Petro; A S Prabhu; D M Krpata; M J Rosen; S Rosenblatt Journal: Hernia Date: 2020-06-15 Impact factor: 4.739
Authors: Tyler J Loftus; Matthew M Ruppert; Tezcan Ozrazgat-Baslanti; Jeremy A Balch; Philip A Efron; Patrick J Tighe; William R Hogan; Parisa Rashidi; Gilbert R Upchurch; Azra Bihorac Journal: JAMA Netw Open Date: 2021-11-01