Concurrent Panniculectomy In The Obese Ventral Hernia Patient: Assessment Of Short-term Complications, Hernia Recurrence, And Healthcare Utilization
Valeriy Shubinets, MD, Justin P. Fox, MD, MHS, Michael N. Mirzabeigi, MD, Michael G. Tecce, DO, Michael A. Lanni, BS, Rachel R. Kelz, MD, MSCE, FACS, Kristoffel R. Dumon, MD, FACS, Joseph M. Serletti, MD, Stephen J. Kovach, MD, John P. Fischer, MD.
University of Pennsyvlania, Philadelphia, PA, USA.
Introduction: Soft-tissue interventions such as panniculectomy (PAN) are often performed concurrently with ventral hernia repair (VHR) in the obese patient. However, the effectiveness and safety profile of this common practice have not been fully established in part due to paucity of comparative effectiveness studies. Presented herein is a comparative analysis of early complications, long-term hernia recurrence, and healthcare expenditures between VHR-PAN and VHR-only patients.
Methods: From the Healthcare Cost and Utilization Project (HCUP) 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 1,013 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]). The 2-year rate of hernia recurrence, however, was lower in the VHR-PAN group (7.9% vs. 11.3%; AOR = 0.65 [0.51-0.82]). Both groups generated significant costs of care (\,805 VHR-PAN vs. \,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 significant need for further comparative effectiveness studies to create the needed framework for evidence-based guidelines.
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