Simultaneous Panniculectomy and Ventral Hernia Repair: A Propensity-Matched Analysis Investigating Safety of the Combined Procedure
Sarah E. Evans, MD1, Manuel Medina, MD2, John Scarborough, MD2, Howard Levinson, MD2.
1University of Cincinnati, Cincinnati, OH, USA, 2Duke University, Durham, NC, USA.
PURPOSE: The optimal timing of panniculectomy in patients with both a symptomatic ventral hernia and abdominal pannus is controversial. While the inclusion of panniculectomy at the time of herniorrhaphy offers several theoretical benefits, published results from small, single-center series suggest that combining the two procedures places patients at excess risk for wound complications and therefore, potentially jeopardizes the hernia repair. The objective of our study was to use information from a large, multicenter repository of surgical patients to better characterize the early 30 day post-operative outcomes of patients who undergo simultaneous panniculectomy and ventral hernia repair to those of a matched cohort of patients undergoing ventral hernia repair alone.
METHODS: All patients from the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program Participant User Files who underwent ventral hernia repair, panniculectomy, or both procedures was included for analysis. Propensity score techniques were used to match patients undergoing ventral hernia repair with or without concurrent panniculectomy for demographic characteristics, comorbid profile, and preoperative physiologic status. The 30-day post-operative outcomes of the two groups were then compared using signed rank tests for continuous outcomes variables and McNemar's chi square tests for categorical variables. Conditional logistic regression analysis was then used to adjust the aforementioned comparisons for operative time. Finally, a descriptive analysis of all patients in our data source who received isolated panniculectomy was also performed to provide a frame of reference.
RESULTS: 841 patients undergoing combined panniculectomy and ventral hernia repair were included for analysis. The overall 30-day post-operative morbidity rate and the incidence of surgical site infection for these patients (22.4% and 14.5%, respectively) was significantly higher than for a well-matched cohort of patients undergoing ventral hernia repair alone (10.9% and 8.1%, both comparisons with p <0.001). After adjusting for duration of operation, however, the difference in overall morbidity between the two groups was not significantly different (adjusted odds ratio for morbidity 1.26 (95% CI 0.87,1.83), p = 0.23). Overall 30-day post-operative morbidity and surgical site infection rates for a separate group of 505 patients undergoing panniculectomy alone were 17.0% and 10.9%, respectively.
CONCLUSIONS: Our study represents the largest series to date of patients undergoing simultaneous panniculectomy and ventral hernia repair. Combining the two procedures does increase the risk of surgical site infection and overall morbidity. This increased risk is explained by the increased operative time required to perform panniculectomy. In addition, isolated panniculectomy is associated with an increased risk of post-operative morbidity and surgical site infection that approaches that of panniculectomy with hernia repair. Taken together, the findings of our analysis suggest that simultaneous panniculectomy and ventral hernia repair increases the risks of surgical site infections but is nonetheless a safe and reasonable approach for patients who display indications for both procedures.
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