What is the BMI threshold for open ventral hernia repair?
Background Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications...
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| Veröffentlicht in: | Surgical endoscopy 2017-03, Vol.31 (3), p.1311-1317 |
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| creator | Pernar, Luise I. M. Pernar, Claire H. Dieffenbach, Bryan V. Brooks, David C. Smink, Douglas S. Tavakkoli, Ali |
| description | Background
Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase. This study aimed to determine the threshold to allow proper patient counseling.
Methods
All patients who underwent open VHR at our institution between 2002 and 2015 captured in the NSQIP database were included. The primary outcome was defined as any (≥1) of 18 captured postoperative complications. Patients were divided into five groups based on BMI: group 1 ( |
| doi_str_mv | 10.1007/s00464-016-5113-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1897385304</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826724876</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-b951ef487917427532ffc9f74278feb96df4baabd285138909b49b982983611b3</originalsourceid><addsrcrecordid>eNqNkU1LAzEQhoMotlZ_gBdZ8OJlNZOPTeYkWvwoVLwoHkO2TeyW7W5NtoL_3pRWEUHwNAPzzDsfLyHHQM-BUnURKRWFyCkUuQTgudwhfRCc5YyB3iV9ipzmTKHokYMY5zThCHKf9JgSggKqPsGXme2yKmbdzGXXD6MUg4uztp5mvg1Zu3RN9u6aLtg6m7nQVDYLbmmrcHlI9rytozvaxgF5vr15Gt7n48e70fBqnE8ElV1eogTnhVYISjAlOfN-gn6da-9KLKZelNaWU6YlcI0US4ElaoaaFwAlH5Czje4ytG8rFzuzqOLE1bVtXLuKBjQqriWn4h8oKxRLuxQJPf2FzttVaNIhiSpQIEOkiYINNQltjMF5swzVwoYPA9SsLTAbC0yywKwtMDL1nGyVV-XCTb87vn6eALYBYio1ry78GP2n6ieqQY1O</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1869492990</pqid></control><display><type>article</type><title>What is the BMI threshold for open ventral hernia repair?</title><source>MEDLINE</source><source>SpringerLink (Online service)</source><creator>Pernar, Luise I. M. ; Pernar, Claire H. ; Dieffenbach, Bryan V. ; Brooks, David C. ; Smink, Douglas S. ; Tavakkoli, Ali</creator><creatorcontrib>Pernar, Luise I. M. ; Pernar, Claire H. ; Dieffenbach, Bryan V. ; Brooks, David C. ; Smink, Douglas S. ; Tavakkoli, Ali</creatorcontrib><description>Background
Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase. This study aimed to determine the threshold to allow proper patient counseling.
Methods
All patients who underwent open VHR at our institution between 2002 and 2015 captured in the NSQIP database were included. The primary outcome was defined as any (≥1) of 18 captured postoperative complications. Patients were divided into five groups based on BMI: group 1 (<25 kg/m
2
); 2 (25–29.99 kg/m
2
); 3 (30–34.99 kg/m
2
); 4 (35–39.99 kg/m
2
); and 5 (≥40 kg/m
2
). Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.
Results
Sixty seven of 922 patients (7.3 %) had at least one postoperative complication following VHR. The adjusted odds of complications in group 5 was 2.89 times greater compared to group 1 (OR 2.89; 95 % CI = 1.22–6.84), while there was no significant differences in odds of postoperative complications for groups 2, 3, or 4 compared to group 1. BMI category was also significantly associated with undergoing recurrent VHR, with 28.7 % of patients in group 5 having a recurrent repair compared to 14 % in patients in group 1 (
p
= 0.03).
Conclusions
After VHR, complications are most likely to occur in patients with BMI ≥ 40 kg/m
2
. This subset of patients also had a significantly higher risk of undergoing surgery for a recurrent hernia, suggesting that this group of patients is likely to experience adverse outcomes after VHR and should be counseled to consider bariatric surgery prior to attempts at VHR. VHR at lower BMIs appears appropriate, and delaying therapy to achieve preoperative weight loss will likely offer no advantage.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-016-5113-5</identifier><identifier>PMID: 27440197</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Body Mass Index ; Chi-square test ; Clinical Decision-Making ; Databases, Factual ; Female ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Hernia, Ventral - surgery ; Hernias ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Obesity ; Obesity - complications ; Overweight ; Patient Selection ; Patients ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Proctology ; Regression analysis ; Reoperation ; Risk Assessment ; Surgeons ; Surgery ; Surgical outcomes ; United States - epidemiology ; Weight control</subject><ispartof>Surgical endoscopy, 2017-03, Vol.31 (3), p.1311-1317</ispartof><rights>Springer Science+Business Media New York 2016</rights><rights>Surgical Endoscopy is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-b951ef487917427532ffc9f74278feb96df4baabd285138909b49b982983611b3</citedby><cites>FETCH-LOGICAL-c405t-b951ef487917427532ffc9f74278feb96df4baabd285138909b49b982983611b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-016-5113-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-016-5113-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27440197$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pernar, Luise I. M.</creatorcontrib><creatorcontrib>Pernar, Claire H.</creatorcontrib><creatorcontrib>Dieffenbach, Bryan V.</creatorcontrib><creatorcontrib>Brooks, David C.</creatorcontrib><creatorcontrib>Smink, Douglas S.</creatorcontrib><creatorcontrib>Tavakkoli, Ali</creatorcontrib><title>What is the BMI threshold for open ventral hernia repair?</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase. This study aimed to determine the threshold to allow proper patient counseling.
Methods
All patients who underwent open VHR at our institution between 2002 and 2015 captured in the NSQIP database were included. The primary outcome was defined as any (≥1) of 18 captured postoperative complications. Patients were divided into five groups based on BMI: group 1 (<25 kg/m
2
); 2 (25–29.99 kg/m
2
); 3 (30–34.99 kg/m
2
); 4 (35–39.99 kg/m
2
); and 5 (≥40 kg/m
2
). Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.
Results
Sixty seven of 922 patients (7.3 %) had at least one postoperative complication following VHR. The adjusted odds of complications in group 5 was 2.89 times greater compared to group 1 (OR 2.89; 95 % CI = 1.22–6.84), while there was no significant differences in odds of postoperative complications for groups 2, 3, or 4 compared to group 1. BMI category was also significantly associated with undergoing recurrent VHR, with 28.7 % of patients in group 5 having a recurrent repair compared to 14 % in patients in group 1 (
p
= 0.03).
Conclusions
After VHR, complications are most likely to occur in patients with BMI ≥ 40 kg/m
2
. This subset of patients also had a significantly higher risk of undergoing surgery for a recurrent hernia, suggesting that this group of patients is likely to experience adverse outcomes after VHR and should be counseled to consider bariatric surgery prior to attempts at VHR. VHR at lower BMIs appears appropriate, and delaying therapy to achieve preoperative weight loss will likely offer no advantage.</description><subject>Abdominal Surgery</subject><subject>Body Mass Index</subject><subject>Chi-square test</subject><subject>Clinical Decision-Making</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Ventral - surgery</subject><subject>Hernias</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Overweight</subject><subject>Patient Selection</subject><subject>Patients</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Proctology</subject><subject>Regression analysis</subject><subject>Reoperation</subject><subject>Risk Assessment</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>United States - epidemiology</subject><subject>Weight control</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU1LAzEQhoMotlZ_gBdZ8OJlNZOPTeYkWvwoVLwoHkO2TeyW7W5NtoL_3pRWEUHwNAPzzDsfLyHHQM-BUnURKRWFyCkUuQTgudwhfRCc5YyB3iV9ipzmTKHokYMY5zThCHKf9JgSggKqPsGXme2yKmbdzGXXD6MUg4uztp5mvg1Zu3RN9u6aLtg6m7nQVDYLbmmrcHlI9rytozvaxgF5vr15Gt7n48e70fBqnE8ElV1eogTnhVYISjAlOfN-gn6da-9KLKZelNaWU6YlcI0US4ElaoaaFwAlH5Czje4ytG8rFzuzqOLE1bVtXLuKBjQqriWn4h8oKxRLuxQJPf2FzttVaNIhiSpQIEOkiYINNQltjMF5swzVwoYPA9SsLTAbC0yywKwtMDL1nGyVV-XCTb87vn6eALYBYio1ry78GP2n6ieqQY1O</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Pernar, Luise I. M.</creator><creator>Pernar, Claire H.</creator><creator>Dieffenbach, Bryan V.</creator><creator>Brooks, David C.</creator><creator>Smink, Douglas S.</creator><creator>Tavakkoli, Ali</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7TS</scope></search><sort><creationdate>20170301</creationdate><title>What is the BMI threshold for open ventral hernia repair?</title><author>Pernar, Luise I. M. ; Pernar, Claire H. ; Dieffenbach, Bryan V. ; Brooks, David C. ; Smink, Douglas S. ; Tavakkoli, Ali</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-b951ef487917427532ffc9f74278feb96df4baabd285138909b49b982983611b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Body Mass Index</topic><topic>Chi-square test</topic><topic>Clinical Decision-Making</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Ventral - surgery</topic><topic>Hernias</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Obesity</topic><topic>Obesity - complications</topic><topic>Overweight</topic><topic>Patient Selection</topic><topic>Patients</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Proctology</topic><topic>Regression analysis</topic><topic>Reoperation</topic><topic>Risk Assessment</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>United States - epidemiology</topic><topic>Weight control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pernar, Luise I. M.</creatorcontrib><creatorcontrib>Pernar, Claire H.</creatorcontrib><creatorcontrib>Dieffenbach, Bryan V.</creatorcontrib><creatorcontrib>Brooks, David C.</creatorcontrib><creatorcontrib>Smink, Douglas S.</creatorcontrib><creatorcontrib>Tavakkoli, Ali</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Physical Education Index</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pernar, Luise I. M.</au><au>Pernar, Claire H.</au><au>Dieffenbach, Bryan V.</au><au>Brooks, David C.</au><au>Smink, Douglas S.</au><au>Tavakkoli, Ali</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What is the BMI threshold for open ventral hernia repair?</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>31</volume><issue>3</issue><spage>1311</spage><epage>1317</epage><pages>1311-1317</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase. This study aimed to determine the threshold to allow proper patient counseling.
Methods
All patients who underwent open VHR at our institution between 2002 and 2015 captured in the NSQIP database were included. The primary outcome was defined as any (≥1) of 18 captured postoperative complications. Patients were divided into five groups based on BMI: group 1 (<25 kg/m
2
); 2 (25–29.99 kg/m
2
); 3 (30–34.99 kg/m
2
); 4 (35–39.99 kg/m
2
); and 5 (≥40 kg/m
2
). Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.
Results
Sixty seven of 922 patients (7.3 %) had at least one postoperative complication following VHR. The adjusted odds of complications in group 5 was 2.89 times greater compared to group 1 (OR 2.89; 95 % CI = 1.22–6.84), while there was no significant differences in odds of postoperative complications for groups 2, 3, or 4 compared to group 1. BMI category was also significantly associated with undergoing recurrent VHR, with 28.7 % of patients in group 5 having a recurrent repair compared to 14 % in patients in group 1 (
p
= 0.03).
Conclusions
After VHR, complications are most likely to occur in patients with BMI ≥ 40 kg/m
2
. This subset of patients also had a significantly higher risk of undergoing surgery for a recurrent hernia, suggesting that this group of patients is likely to experience adverse outcomes after VHR and should be counseled to consider bariatric surgery prior to attempts at VHR. VHR at lower BMIs appears appropriate, and delaying therapy to achieve preoperative weight loss will likely offer no advantage.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27440197</pmid><doi>10.1007/s00464-016-5113-5</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Surgical endoscopy, 2017-03, Vol.31 (3), p.1311-1317 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; SpringerLink (Online service) |
| subjects | Abdominal Surgery Body Mass Index Chi-square test Clinical Decision-Making Databases, Factual Female Gastroenterology Gastrointestinal surgery Gynecology Hepatology Hernia, Ventral - surgery Hernias Humans Male Medicine Medicine & Public Health Middle Aged Obesity Obesity - complications Overweight Patient Selection Patients Postoperative Complications - etiology Postoperative Complications - prevention & control Proctology Regression analysis Reoperation Risk Assessment Surgeons Surgery Surgical outcomes United States - epidemiology Weight control |
| title | What is the BMI threshold for open ventral hernia repair? |
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