title: Among 1,706 cases of abdominal wall reconstruction, what factors influence the occurrence of major operative complications?
abstract: BACKGROUND
  Abdominal wall reconstruction (AWR) poses a substantial operative challenge, often in the setting of multiple failed attempts at repair in high-risk patients. Our aim was to assess risk factors for major operative morbidity after AWR using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) patient database.
  
  
  METHODS
  A review of the ACS-NSQIP database of outcomes from 2005 to 2010 was performed to identify patients undergoing AWR utilizing Current Procedural Terminology codes for ventral hernia repair and a concomitant component separation. Independent variables included patient demographics, medical comorbidities, and operative considerations. Major operative complication (deep wound infection, graft or prosthetic loss, or unplanned return to the operating room within 30 days) was used as our dependent variable. Stepwise, multivariate logistic regression was performed to evaluate patient risk factors influencing the occurrence of major operative complications.
  
  
  RESULTS
  We identified 1,706 patients with an average age of 55.9 ± 12.8 years with 30.1% undergoing concurrent intra-abdominal procedures and 57.1% undergoing mesh repair. Notable medical comorbidities included obesity (63.4%), smoking (24.9%), hypertension (53.1%), diabetes (19.9%), and anemia (22.6%). Average operative time was 211.7 ± 105.0 minutes. Regression analysis determined that prolonged operative time (odds ratio [OR], 2.7; P < .001) and American Society of Anesthesiologists >2 (OR, 1.8; P = .009) were positively associated, whereas advanced age (OR, 0.5; P = .005) was negatively associated with the occurrence of major operative complications.
  
  
  CONCLUSIONS
  Greater operative times and overall patient health are important prognostic factors for individuals undergoing AWR. The increased physiologic stress of a greater operative duration on patients who often have multiple comorbidities seems to play a significant role in predicting negative outcomes after AWR.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: stephen.kovach@uphs.upenn.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology