Rumbidzayi Nzara, MD, Sowmya R Rao, PhD, Luise I Pernar, MD. Boston University School of Medicine
INTRODUCTION – While it is clear that extreme obesity is associated with increased postoperative complications after open ventral hernia repair (VHR), the threshold BMI beyond which complications increase is not certain. Predominantly single institution data has been evaluated to address this question. The aim of this study was to analyze multi-institutional perioperative outcomes of patients undergoing open VHR stratified by BMI.
METHODS AND PROCEDURES – Patients undergoing open VHR were identified in the 2002 – 2015 National Surgical Quality Improvement Program (NSQIP) data sets. Patients were divided into eight groups based on BMI in kg/m2: Group 1 (<25); 2 (25–29.9); 3 (30–34.9); 4 (35–39.9); 5 (40-44.9); 6 (45-49.9); 7 (50-54.9); 8 (>=55). The primary outcome was defined as any of 18 captured postoperative complications. Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.
RESULTS – 131,922 patients in the data set had undergone open VHR. Operative time increased with increasing BMI; Mean procedure time for normal weight individuals was 77.6 minutes while individuals with BMI over 35kg/m2 had mean times of 106.5 minutes, 113.4 minutes, 118.2 minutes, 118.5 minutes and 128 minutes for Groups 4 to 8 respectively. 7.6% of patients had at least one complication after VHR. While 6.4% of patients in Group 1 experienced a complication, 6 % had a complication in Group 2, 6.9% in Group 3, 8.1 % in Group 4, 10.2% in Group 5, 12.2 % in Group 6, 13% in Group 7 and 17.5% in Group 8. The complication most frequently observed was a surgical site infection. Using the normal weight patients in Group 1 as a reference standard, the adjusted odds of experiencing any complication was 0.92 for patients in Group 2; 1.07 in Group 3; 1.30 in Group 4; 1.70 in Group 5; 2.11 in Group 6; 2.24 for Group 7 and 3.36 for Group 8.
CONCLUSIONS – Our results demonstrate that BMI over 35kg/m2 appears to be the threshold above which complications with open VHR begin to rise. However, the odds of complications continue to rise at the extremes of BMI. Based on these results, surgeons should consider recommending weight loss by lifestyle changes or bariatric surgery for patients with BMI over 35kg/m2 to decrease risk of complications. Delay of elective VHR until weight loss can be achieved should be strongly considered in patients with BMI above 40kg/m2.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87898
Program Number: P045
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster