title: Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes.
abstract: BACKGROUND
  Obesity's influence on postoperative complications in either laparoscopic ventral hernia repair (LVHR) or open ventral hernia repair (OVHR) has yet to be defined. Although 30-day postoperative complications increase with higher body mass index (BMI), we propose LVHR minimizes surgical site infections (SSIs) and surgical site occurrences (SSOs) for given BMI categories.
  
  
  METHODS
  Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2009 to 2012) for patients aged 18 years or more undergoing elective ventral hernia repair. Exclusion criteria included immunosuppression, disseminated malignancy, advanced liver disease, or pregnancy. Patients were stratified by BMI (20 to 25, 25 to 30, 30 to 35, 35 to 40, and >40 kg/m(2)), and 30-day SSOs evaluated across BMI groups for LVHR vs OVHR.
  
  
  RESULTS
  A total of 106,968 patients met inclusion criteria, with 60% patients obese. LVHR decreased SSO for all patients (odds ratio, .4; confidence interval, .19 to .60). Obesity classes I/II/III have increased odds of superficial SSI, deep SSI, and dehiscence for OVHR compared with LVHR. Only obesity class III has increased odds of organ space SSI and reoperation for OVHR vs LVHR (P < .05).
  
  
  CONCLUSIONS
  Obese patients are over-represented in VHRs. Thirty-day postoperative wound complications increase with higher BMI. LVHR minimizes both SSIs and SSOs, especially in higher obesity classes.
authors.affiliation: Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA. Electronic address: jregner@sw.org.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Regner
authors.affiliation: Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Mrdutt
authors.affiliation: Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Munoz-Maldonado
mesh_terms: D000328:Adult; D015992:Body Mass Index; D017558:Elective Surgical Procedures; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: BMI classes; Laparoscopic ventral hernia repair; NSQIP; Obesity; Postoperative wound infection