title: Advanced age does not affect abdominal wall reconstruction outcomes using acellular dermal matrix: A comparative study using propensity score analysis.
abstract: BACKGROUND
  We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal wall reconstruction (AWR) for hernia or oncologic resection.
  
  
  METHODS
  We included all consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) between 2005 and 2015. Propensity score analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The primary outcome was hernia recurrence; the secondary outcomes included surgical site occurrence (SSO) and bulging.
  
  
  RESULTS
  Mean follow-up for the 511 patients was 31.4 months; 184 (36%) patients were elderly. The elderly and non-elderly groups had similar rates of hernia recurrence (7.6% vs 10.1%, respectively; p = 0.43) and SSO (24.5% vs 23.5%, respectively; p = 0.82). Bulging occurred significantly more often in elderly patients (6.5% vs 2.8%, respectively; p = 0.04). After adjustment through the propensity score, which included 130 pairs, these results persisted.
  
  
  CONCLUSIONS
  Contrary to our hypothesis, elderly patients did not have worse outcomes in AWR with ADM. Surgeons should not deny elderly patients AWR solely because of their age.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Schaverien
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: cbutler@mdanderson.org.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D058107:Abdominal Wound Closure Techniques; D062088:Acellular Dermis; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Abdominal wall; Acellular dermal matrix; Advanced age; Elderly; Hernia; Old; Postoperative complications; Strattice; SurgiMend; Surgical mesh