| Autor: |
Hallway, Alexander K., Sinamo, Joshua K., Fry, Brian T., Kappelman, Abigail L., Huynh, Desmond, Schoel, Leah J., O’Neill, Sean M., Rubyan, Michael, Shao, Jenny M., Telem, Dana A., Ehlers, Anne P. |
| Zdroj: |
Surgical Endoscopy; 20240101, Issue: Preprints p1-7, 7p |
| Abstrakt: |
Introduction: Obesity is a known risk factor for postoperative complication after ventral or incisional hernia repair (VIHR). Whether minimally invasive techniques can mitigate this risk for certain patients remains unknown. This study investigates whether MIS approaches offer advantages in reducing any medical or surgical complication after VIHR across clinically meaningful BMI categories. Methods: This study analyzes data from the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR). The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan. This study includes adult patients receiving VIHR between Jan 2020 and September 2023. All elective VIHRs captured in the MSQC database were included in analysis. Univariate statistics were used for cohort summary and multivariate logistic regression was used to estimate the probability of any 30-day postoperative complication while controlling for age, sex, the interaction of BMI and surgical approach, medical comorbidities, hernia size, mesh use, use of component separation, and previous hernia repair. Results: A total of 11,886 people met the study inclusion criteria. The median (IQR) age was 55.0 (44–65) and 5,111(43.0%) were female. The median (IQR) BMI was 31.7 (27.6–36.3). 5,260(44.3%) cases were performed with an MIS approach and 6,626(55.7%) were performed with an open approach. The adjusted relative risk of experiencing a complication after open repair when compared to MIS repair was 1.34 (95% CI [1.04–1.70], p= .02) in Obesity Class I, 1.62 (95% CI [1.23–2.14], p< .001) in Obesity Class II, and 2.31 (95% CI[1.49–3.56]) for Obesity Class III. Conclusions: MIS repair was associated with improved 30-day outcomes for patients with class I, II, and III obesity, but not for healthy to overweight patients. In clinical scenarios where delay for severely obese patients may be difficult, electing to use an MIS repair may be the optimal strategy to reduce risk of complications. |
| Databáze: |
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