Postoperative Outcome Of Ventral Hernia Repair In Veterans
*Awni D Shahait1, *Lana Alghanem2, *Peter Cmorej1, *Mustafa Rashad Hasnain3, *Mohanad Baldawi3, *Kara Girten3, Donald Weaver1, *Khaled J Saleh3, Scott A. Gruber3, Gamal Mostafa1
1Wayne State University School of Medicine, Detroit, MI;2Wayne State University, Detroit, MI;3John D. Dingell VA Medical Center, Detroit, MI
Objective(s):Ventral hernia repair (VHR) is a common procedure with current outcomes reporting 15-37% morbidity and 0.3-1.4% mortality. This study examines the postoperative outcome of open (OVHR) and laparoscopic (LVHR) VHR in veterans.Methods:The Veterans Affairs Surgical Quality Improvement Program was queried for all VHRs during the period 2008-2015. Data collection included patient demographics, operative details, and postoperative outcomes. Univariate and multivariate regression analyses were used and a p-value of ≤0.05 was considered significant.Results:A total of 19,883 patients were identified (92.6% males, mean age 59.7 years, mean BMI 31.1 with 53.1% obese [BMI ≥30], 71.6% with ASA class ≥III, and 31.6% active smokers). Mean operative time (OT) was 1.8 hr, and only 6.7% were emergency procedures. There were 95 (0.5%) mortalities and complications occurred in 1,289 (6.5%) patients, with superficial surgical site infection (SSI) 1.9%, deep SSI 0.6%, and reoperation rate 3%. Mean postoperative length of stay (LOS) was 4.4 days. OVHR was performed in 60.2% and LVHR in 39.8% of patients. When compared with OVHR, the LVHR group had higher mean BMI (31.6 vs. 30.7, p<0.001), less ASA class ≥III (68.8% vs. 74.1%, p<0.001), less emergency operations (1.6% vs. 4.6%, p<0.001), longer OT (1.8 hr vs. 1.7 hr, p<0.001), fewer complications (3.9% vs. 7.5%, p<0.001), less mortality (0.3% vs. 0.6%, p=0.002), and shorter LOS (3.4 vs. 4.9 days, p<0.001). BMI ≥35 was significantly associated with an overall increase in complications (p<0.001). The negative impact of morbid obesity was significant only in OVHR cases (p=0.033) and did not affect LVHR outcome (p=0.36).Conclusion:In a high-risk veteran population, VHR is being performed with excellent morbidity and mortality. While surgeons tended to avoid performing LVHR in the highest-risk patients and/or in emergency settings, the overall superior results of LVHR suggest that it should be more broadly applied, particularly in the morbidly obese patient.
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