Alyssa Fesmire, MD1, Matthew Marr, MD1, Marissa Mendez, MD1, G. Brent Sorensen, MD2. 1University of Missouri Kansas City, 2Saint Luke’s Hospital of Kansas City
INTRODUCTION: Obesity is a modifiable risk factor for complications following abdominal wall reconstruction (AWR). Patients with a body mass index (BMI) greater than 30 have an increased risk of wound complications and hernia recurrence compared to patients with a BMI less than 30. We sought to evaluate predicted risk and cost reduction in patients who underwent bariatric surgery prior to AWR.
METHODS AND PROCEDURES: We identified 10 patients who underwent sleeve gastrectomy (SG) or Roux-en-y gastric bypass (RNYGB) prior to AWR. Procedures were performed by a single surgeon at a high-volume tertiary center. A retrospective chart review was performed to obtain demographics, weight measurements, BMI, and complications. The Carolinas Equation for Determining Associated Risks (CEDAR) is a validated questionnaire used to predict the complication risk and financial impact of wound complications in hernia repair. CEDAR predictions were used to compare the risk reduction and cost reduction associated with preforming a bariatric procedure prior to AWR.
RESULTS: Of the 10 patients, 7 underwent RNYGB and 3 underwent SG. The mean time from bariatric procedure to AWR was 12.8 months. There was no statistically significant difference in weight loss or BMI reduction between the two procedures (RNYGB=70.5 lbs, SG=67.3 lbs, p=0.65; RNYGB=9.6 kg/m2, SG=12 kg/m2, p=0.50). Patients lost a mean 70 lbs (p=0.007) with a mean BMI reduction of 9.6 kg/m2 (p<0.001) prior to AWR. This correlated with a mean CEDAR-predicated risk reduction of 18.7% (p=0.02) and mean CEDAR-predicated associated cost reduction of $12,875.80 (inpatient cost=$3,808.40, follow up cost= $9,067.40, p=0.04).
CONCLUSION: Bariatric surgery effectively improves predicted risk reduction and financial burden for high risk patients prior to AWR. Morbidly obese patients with large abdominal hernias may benefit from a bariatric procedure prior to definitive hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94991
Program Number: P578
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster