Chronic Immunosuppression Use Is A Poor Predictor For Wound Complications Following Transversus Abdominis Release
*Bradley S Kushner, *Britta Han, *Arnab Majumder, *Sara E. Holden, *Jeffrey Blatnik
Washington University in St. Louis, SAINT LOUIS, MO
Objective: Transversus Abdominis Release (TAR) is an effective procedure for complex ventral hernias. However, the open approach is associated with surgical site occurrences in up to 20-30% of patients. As wound complications increase hernia recurrence rate, mitigating risk factors is vitally important for hernia surgeons. Although immunosuppression is linked with impaired wound healing, it has inconsistently predicted wound occurrences following ventral hernia repairs. Furthermore, data regarding its effect on wound morbidity, specifically following TAR, is unknown. This study evaluates the effect of chronic immunosuppression use on postoperative wound occurrences in patients undergoing TAR. Methods: Patients undergoing either an open or robotic bilateral TAR with permanent synthetic mesh were stratified by the use of perioperative chronic immunosuppression (steroids, antimetabolites, antibodies, and antirejection medications) and secondarily stratified by both immunosuppression use and procedure type (open vs. robotic). Patients undergoing emergent/urgent cases and combined procedures (i.e. colorectal/urological) were excluded. Demographic information, perioperative data, and 30-day wound complications were analyzed. Results: A total of 300 patients were included for analysis. Overall, 62 (20.7%) patients were on perioperative chronic immunosuppression with history of solid-organ transplant being the most common indication (42 patients). Patients stratified by perioperative immunosuppression were well-matched with similar defect size (p=0.65), %BMI>30 (p=0.40), diabetes (p=0.14), history of SSI (p=0.75), operative time (p=0.67), %open procedures (p=0.36), tobacco use history (0.71), and American Society of Anesthesia (ASA) class (p=0.41). No differences in any wound events existed between cohorts stratified by immunosuppression use (Table 1). Similarly, when stratified further by procedure type, there were again no differences in wound complications (Table 1). Conclusion: Chronic immunosuppression is hypothesized to predispose patients to wound occurrences following major open surgery. However, our data suggests that following TAR, immunosuppression use may not significantly increase the risk of perioperative wound morbidity as previously predicted. Further study should focus on whether specific classes of immunosuppression places patients at increased risk for wound occurrences and whether minimally invasive TARs (vs. open) may be protective of these effects.
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