Maria S Altieri1, Jie Yang, PhD1, Angelina Voronina, MS2, Tyler Jones, MS1, Andrew Bates, MD1, Mengru Zhang, MS1, Mark Talamini, MD1, Angela Kokkosis, MD1, Aurora Pryor, MD1. 1Stony Brook Medical Center, 2New York Institute of Technology College of Osteopathic Medicine
Introduction: Ventral hernia repair (VHR) is a known complication of open abdominal surgery. As patients with aneurysmal disease have weak connective tissue and fascia due to the biological makeup of their collagen, we suspected that patients following open abdominal aortic aneurysm (AAA) procedures were at increased risk for hernia. The purpose of our study was to evaluate the rate of VHR following open AAA in New York State (NYS) compared to the rate of VHR following open abdominal aortic bypass procedures.
Methods: Using ICD-9 codes, the SPARCS database was queried for all AAA and bypass procedures performed between 2000-2010. Using a unique identifier, patients were followed for at least four years (up to 2014). Exclusion criteria include age <18 years, patients with multiple abdominal procedures, and missing data. Social security death index (SSDI) was used to identify patients who expired. Chi-square test was utilized to compare categorical variables between patients having AAA and those having bypass. The cause-specific Cox proportional hazard model for competing risk event was applied to compare the risk of having follow-up VHR between patients with AAA and bypass. Variables which were significant in the univariate models with p-value<0.05 were further included in a multivariable model to explore independent relationship with the risk of having follow-up ventral hernia after adjusting for
Results: There were 9,314 patients who underwent open AAA repair, 739 (7.93%) of which had subsequent VHR. Comparatively, 8280 patients underwent aortofemoral or aortoiliac bypass procedures, with 480 (5.8%) undergoing subsequent VHR between 2000-2014. The average time to VHR after initial surgery is 849.48±927.66 days for patients with AAA procedure and 992.13±988.56 days for patients with Bypass repair. The observed 1-year, 5-year, and 10-year VHR rates for AAA versus Bypass were 2.8% (229 out of 7970) vs 1.8% (122 out of 6876), 10.0% (528 out of 5257) vs 8.0% (341 out of 4241), 10.7% (185 out of 1732) vs 9.38% (124 out of 1322), respectively. After controlling for all other factors, patients undergoing AAA repair were more likely and elderly patients were less likely to undergo VHR (p<0.0001). Patients with serious co-morbid conditions such as valvular disease, DM, neurologic disorders, renal failure were less likely to undergo subsequent VHR controlling for other factors (P<0.05).
Conclusion: VHR following AAA procedures is significantly more common compared to bypass procedures. Given these findings, prophylactic mesh placement in this patient population with aneurysmal disease may prevent future interventions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79821
Program Number: P030
Presentation Session: Poster (Non CME)
Presentation Type: Poster
