title: Concurrent panniculectomy with open ventral hernia repair has added risk versus ventral hernia repair: an analysis of the ACS-NSQIP database.
abstract: BACKGROUND
  Recent studies have assessed the risks and benefits of performing concurrent panniculectomy (PAN) in the setting of hernia repair, gynecologic surgery, and oncologic resections with conflicting results. The aim of this study is to assess the added risk of ventral hernia repair and panniculectomy (VHR-PAN) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data sets.
  
  
  METHODS
  The 2005-2011 ACS-NSQIP databases were queried to identify all patients undergoing VHR alone or VHR-PAN. Propensity scores were used to account for potential selection bias given the non-randomized assignment of concurrent panniculectomy and the retrospective nature of this study. Multivariate logistic regression analyses were used to assess the impact of concurrent PAN on complications.
  
  
  RESULTS
  A total of 55,537 patients were identified. Propensity matching yielded two groups of patients: VHR (n = 1250) and VHR-PAN (n = 1250). Few statistically significant differences existed between matched cohorts. Overall, wound complications (P < 0.001), venous thromboembolism (P = 0.044), incidence of reoperation (P < 0.001), and medical morbidity (P < 0.001) were significantly higher in the VHR-PAN group. In an adjusted, fixed-effects analysis, concurrent panniculectomy was associated with wound healing complications (OR = 1.69, P < 0.001), increased incidence of unplanned reoperations (OR = 2.08, P ≤ 0.001), venous thromboembolism (OR = 2.48, P = 0.043), and overall medical morbidity (OR = 2.08, P < 0.001). Sub-group analysis of wound complications demonstrated that superficial surgical site infections occurred significantly more often in concurrent cases (P = 0.018).
  
  
  CONCLUSIONS
  This analysis quantifies the added risk of performing a panniculectomy concurrent with ventral hernia repair, demonstrating higher incidence of wound complications (superficial infections), unplanned reoperations, and VTE.
  
  
  METHODS
  Prognostic/risk category, level II.
authors: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: John.Fischer2@uphs.upenn.edu.
authors: John P
authors: JP
authors: Fischer
authors: Section of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA.
authors: Charles T
authors: CT
authors: Tuggle
authors: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Ari M
authors: AM
authors: Wes
authors: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Stephen J
authors: SJ
authors: Kovach
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D016208:Databases, Factual; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects*; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D054556:Venous Thromboembolism / Q000209:etiology
keywords: ACS-NSQIP; Complications; Concurrent; Hernia repair; Outcomes; Panniculectomy; Propensity matching