A population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: can it be performed safely?
Morbid obesity is increasing at an alarming rate and a significant portion of patients presenting for complex abdominal wall reconstruction (AWR) and component separation fall into this category, creating added medical and surgical challenges to an already difficult operation. The goal of this study was to utilise the Nationwide 2005-2010 American College of Surgeons National Surgical Quality Improvement database (ACS-NSQIP) to perform a population level analysis of the role of morbid obesity on 30-day perioperative morbidity with the hope of improving patient care, counselling and risk stratification. Morbidly obese patients (BMI > 40 kg/m(2)) were compared to non-obese patients (BMI < 30 kg/m(2)). Outcome variables assessed included major surgical complications, major medical complications, major renal complications, major wound complications, return to OR (ROR), and venous thromboembolism (VTE). Significant variables in a univariate analysis were included in a multivariate logistic regression controlling for patient characteristics (p < 0.05). In total, 1695 patients undergoing AWR were identified in the ACS-NSQIP database. Of these, 614 patients were non-obese (average BMI = 25.7 ± 3.0 kg/m(2)) and 314 were morbidly obese (average BMI = 45.9 ± 5.8 kg/m(2)). Multivariate analyses determined that morbid obesity did not significantly contribute to major surgical, medical, renal or wound complications. However, it was significantly associated with ROR (OR = 2.8, p < 0.001) and VTE (OR = 5.2, p = 0.04). Morbid obesity is an independent risk factor for ROR and VTE related complications, in the 30 day post-operative period. Additional perioperative care is warranted to decrease such early re-operations and for preventable complications.
Division of Plastic Surgery, Hospital of the University of Pennsylvania , Philadelphia, PA , USA.
Jonas A
JA
Nelson
John P
JP
Fischer
Jason D
JD
Wink
Stephen J
SJ
Kovach
D034861:Abdominal Wall / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D061214:Patient Safety; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
Abdominal wall reconstruction; American College of Surgeons–National Surgical Quality Improvement; component separation; incisional hernia; morbidly obese; ventral hernia