title: Abdominal wall reconstruction in the obese: an assessment of complications from the National Surgical Quality Improvement Program datasets.
abstract: BACKGROUND
  This study utilizes the American College of Surgeons National Surgical Quality Improvement Program database to better understand the impact of obesity on perioperative surgical morbidity in abdominal wall reconstruction (AWR).
  
  
  METHODS
  We reviewed the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program databases, identifying cases of AWR and examining early complications in the context of obesity (body mass index > 30, World Health Organization classes 1 to 3).
  
  
  RESULTS
  Of 1,695 patients undergoing AWR, 1,078 (63.2%) patients were obese (mean body mass index = 37.6 kg/m(2)). Major surgical complications (15.3% vs 10.1%, P = .003), wound complications (12.5% vs 8.1%, P = .006), medical complications (16.2% vs 11.2%, P = .005) and return to the operating room (9.1% vs 5.4%, P = .006) were significantly increased, while renal complications (1.9% vs .8%, P = .09) neared significance. On logistic regression, obesity only directly led to a significantly increased odds of having a renal complication (odds ratio = 4.4, P = .04). Complications were still noted to increase with World Health Organization classification, including a concerning incidence of venous thromboembolism.
  
  
  CONCLUSIONS
  Although the incidence of complications increased with obesity, obesity itself does not appear to increase the odds of perioperative morbidity. Specific care should be given to VTE prophylaxis and to preventing renal complications.
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address: jonas.nelson@uphs.upenn.edu.
authors: Jonas A
authors: JA
authors: Nelson
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors: John P
authors: JP
authors: Fischer
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors: Emily C
authors: EC
authors: Cleveland
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors: Jason D
authors: JD
authors: Wink
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors: Joseph M
authors: JM
authors: Serletti
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors: Stephen J
authors: SJ
authors: Kovach
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000150:complications / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D015397:Program Evaluation; D058996:Quality Improvement; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Abdominal wall reconstruction; Complications; Component separation; Hernia; NSQIP