title: Concurrent panniculectomy in the obese ventral hernia patient: Assessment of short-term complications, hernia recurrence, and healthcare utilization.
abstract: BACKGROUND
  Panniculectomy (PAN) is often performed concurrently with ventral hernia repair (VHR) in the obese patient. However, the effectiveness and safety profile of this common practice are not fully established in part because of paucity of comparative effectiveness studies. In this study, a comparative analysis of early complications, long-term hernia recurrence, and healthcare expenditures between VHR-PAN and VHR-only patients is presented.
  
  
  METHODS
  From the Healthcare Cost and Utilization Project database, obese patients who underwent VHR with and without concurrent PAN were identified. Multivariate cox proportional-hazards regression modeling was performed to compare outcomes between the two groups.
  
  
  RESULTS
  The final cohort included 1013 VHR-PAN and 18,328 VHR-only patients. The VHR-PAN patients experienced a longer adjusted length of hospital stay (6.8 days vs. 5.2 days; p < 0.001), a higher rate of in-hospital adverse events (29.3% vs. 20.7%; AOR = 2.34 [2.01-2.74]), and a higher rate of 30-day readmissions (13.6% vs. 8.1%; AOR = 2.04 [1.69-2.48]). However, the 2-year rate of hernia recurrence was lower in the VHR-PAN group (7.9% vs. 11.3%; AOR = 0.65 [0.51-0.82]). Both groups generated considerable hospital charges ($104,805 VHR-PAN vs. $72,206 VHR-only, p < 0.001).
  
  
  CONCLUSIONS
  Performing a concurrent PAN in the obese hernia patient is associated with a higher rate of early complications and greater healthcare expenditures, but overall a substantially lower incidence of 2-year hernia recurrence. The literature review presented here also highlights a substantial need for further comparative effectiveness studies to create the needed framework for evidence-based guidelines.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Valeriy
authors.initials: V
authors.lastname: Shubinets
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tecce
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mirzabeigi
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Lanni
authors.affiliation: Division of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Kristoffel R
authors.initials: KR
authors.lastname: Dumon
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA. Electronic address: John.Fischer2@uphs.upenn.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
mesh_terms: D061645:Abdominoplasty / Q000009:adverse effects*; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D010342:Patient Acceptance of Health Care; D010359:Patient Readmission; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies
keywords: Concurrent panniculectomy; HCUP; Hernia repair; Obesity