Concurrent Panniculectomy With Open Ventral Hernia Repair Versus Ventral Hernia Repair: An Analysis Of The ACS-NSQIP Database
Waleed R. Rashid, B.S.1, Cindy Gombaut, B.S.2, David Kahn, M.D.1, Jennifer Goldman, B.S.2.
1Stanford University School of Medicine, Palo Alto, CA, USA, 2George Washington University, Washington, DC, USA.
PURPOSE: Previous studies have assessed the risks and benefits of performing concurrent panniculectomy (PAN) in the setting of ventral hernia repair (VHR), gynecologic surgery, and oncologic resections demonstrating the added risks of a combined VHR-PAN procedure vs VHR-alone. We aim to update the literature with 10 years of data while also suggesting guidelines of care.
METHODS: The ACS-NSQIP databases were queried to identify all patients undergoing VHR alone, VHR-PAN, or PAN alone between the years 2010 to 2020. Propensity scores were used to account for potential selection bias given the non-randomized assignment of concurrent panniculectomy and the retrospective nature of this study. Multivariate logistic regression analyses were used to assess the impact of concurrent PAN on complications.
RESULTS: A total of 113,880 patients were identified. Propensity matching yielded two groups of patients, VHR (n = 2268), VHR-PAN (n = 2268), with little statistically significant differences between matched cohorts. Overall, deep vein thrombosis (p = 0.018), pulmonary embolism (p = 0.005), return to OR (p < 0.001), acute renal failure occurrences (p = 0.029) were significantly higher in the VHR-PAN group. In an adjusted, fixed-effects analysis, VHR-PAN was associated with wound healing complications (p = .034), Superficial Incisional SSI Occurrences (p = <.001), and Deep Incisional SSI Occurrences (P = .04).
CONCLUSION: This analysis quantifies the added risk of performing a PAN concurrent with VHR, demonstrating the higher incidence of wound complications (both superficial and deep infections), unplanned reoperations, and DVT/PE. Guidelines of care have been suggested based on patient risk.
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