RESUMO
BACKGROUND: A large proportion of patients presenting for ventral hernia repair are obese. It remains unclear, however, whether the degree of obesity is an independent risk factor for adverse outcomes after ventral hernia repair. This study aims to characterize the influence of body mass index class on postoperative complications after open ventral hernia repair. METHODS: A retrospective analysis was conducted using data from the database of the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015. Patients were stratified into 7 body mass index classes, as well as by type of hernia (reducible versus strangulated) and time of repair (initial versus recurrent). We determined the relationships between body mass index class and patient demographics, comorbidities, and risk of perioperative complications. RESULTS: Our cohort consisted of 102,191 patients, 58.5% of whom were obese. When stratified by body mass index class, higher classes were associated with all postoperative complications (P < .0001) with a steady increase in complication rates with increasing body mass index class. Patients with strangulated hernias had greater complication rates than those with reducible hernias (P < .0001). Patients with recurrent hernias also had greater complication rates than those with initial hernias (P < .0001). CONCLUSION: Increased body mass index is a risk factor for operative, medical, and respiratory complications after open ventral hernia repair. Patients with body mass index >40 kg/m2 have greater than twice the risk for complications with odds ratios increasing with increasing body mass index class. Strategies to encourage weight loss may need to be considered seriously prior to open ventral hernia repair, especially for patients with body mass index >40 kg/m2.
Assuntos
Índice de Massa Corporal , Hérnia Ventral/cirurgia , Herniorrafia , Obesidade/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Bases de Dados Factuais , Feminino , Hérnia Ventral/complicações , Herniorrafia/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Obesity is a risk factor for cholelithiasis leading to acute cholecystitis which is treated with cholecystectomy. The purpose of this study was to analyze the associations between body mass index class and the intended operative approach (laparoscopic versus open) for and outcomes of cholecystectomy for acute cholecystitis. METHODS: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program data from 2008-2013. The effects of body mass index class on intended procedure type (laparoscopic versus open), conversion from laparoscopic to open operation, and outcomes after cholecystectomy were examined using multivariable logistic regression. RESULTS: Data on 20,979 patients who underwent cholecystectomy for acute cholecystitis showed that 18,228 (87%) had a laparoscopic operation; 639 (4%) of these patients required conversion to an open approach; and 2,751 (13%) underwent intended open cholecystectomy. There was an independent association between super obesity (body mass index 50+) and an intended open operation (odds ratio 1.53, 95% confidence interval 1.14-2.05, P = .01). An intended open procedure (odds ratio 3.10, 95% confidence interval 2.40-4.02, P < .0001) and conversion (odds ratio 3.45, 95% confidence interval 2.16-5.50, P < .0001) were associated with increased risk of death/serious morbidity in a model, even when controlling for all other important factors. In the same model, body mass index class was not associated with increased death/serious morbidity. Outcomes after conversion were not substantially worse than outcomes after intended open cholecystectomy. CONCLUSION: This study supports the possibility that an intended open approach to acute cholecystitis, not body mass index class, is associated with worse outcomes after cholecystectomy. An initial attempt at laparoscopy may benefit patients, even those at the highest end of the body mass index spectrum.