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Concomitant Panniculectomy With Abdominal Wall Reconstruction (CP-AWR): A Propensity-Scored Matched Study Of Quality Improvement Over 21-years
Alexis M. Holland, MD, William R. Lorenz, MD, Brittany S. Mead, MD, Gregory T. Scarola, MS, B. Todd Heniford, MD, Vedra A. Augenstein, MD;
Carolinas Medical Center, Charlotte, NC, USA
Purpose: CP-AWR as a single-stage, complex operation has reported increased complications rates, but constant quality improvement with enhanced-recovery-after-surgery protocols can ameliorate surgical outcomes. This study describes the progressive outcomes over 21-years as impacted by evidence-based changes of our practice. Methods: Prospectively maintained data from a tertiary-hernia-center was reviewed for patients undergoing CP-AWR. Patients were separated by surgery date into “early” (2002-2016) (EG) and “recent” (2017-2023) groups (RG) based on panniculectomy technique. Propensity-scored matching was performed in 1:1 fashion based on age, body mass index (BMI), defect-size, tobacco-use, ASA, and wound-class. Results: Of 701 CP-AWR patients, 196 patients were matched per group. EG and RG were comparable in age (57.6±11.4vs57.4±11.6years), sex (76.5%vs73.0%female), active smokers (4.6%vs4.6%), diabetes (35.7%vs30.1%), number of comorbidities (4.6±2.3vs5.0±2.5), ASA (63.8%vs67.9%ASA-III), wound-class (69.6%vs69.9%clean), and defect-size (264.4±260.4vs272.2±207.5cm2), but differed by BMI (34.6±7.2vs32.1±6.01kg/m2;p=0.001) and recurrent hernias (71.4%vs56.1%;p=0.002). Intraoperative techniques differed between groups (Table1). Overall wound complications decreased over time (Table1). Readmission and reoperation did not differ, but length of stay decreased (8.3±6.7vs6.5±3.4days;p=0.001). Hernia recurrence rates improved (6.6%vs1.5%;p=0.019), but follow-up was shorter (50.9±52.8vs22.9±22.6months;p<0.0001). Diabetes (OR[95%CI]=2.098[1.310,3.360];p=0.002) was the only independent predictor of wound complications on regression. Conclusion: Despite greater patient complexity, outcomes of CP-AWR improved with implementation of evidence-based-practice changes in preoperative optimization, intraoperative technique, and postoperative care. This large set of patients demonstrates the safety of a single-stage repair that should be part of hernia surgeons’ repertoire.
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