Impact of obesity on postoperative 30-day outcomes in emergent open ventral hernia repairs

Abstract

Background: Anecdotally, obese patients experience increased morbidity with emergent ventral hernia repair (VHR). We hypothesized obese patients are over-represented in emergent VHRs and experience increased 30-day morbidity.

Methods: American College of Surgeons National Surgical Quality Improvement Program database (2011 to 2013) was queried for patients undergoing open VHR. Patients were stratified by body mass index (BMI) categories: underweight, normal weight, overweight, and obesity classes I, II, and III; 30-day postoperative complications (surgical site infections, return to operating room, dehiscence, death) were evaluated across BMI for elective vs emergent VHR.

Results: In all, 39,822 patients were included: 7.3% emergent. Obese classes I to III represented higher percent of emergent VHRs (55.8% vs 68.9%). Complication rate doubled for emergent group (7.2% vs 14.5%), and likelihood of at least one complication increased with BMI for emergent vs normal weight-elective VHR (overweight odds ratio, 2.2; 95% confidence interval, 1.4 to 3.4; class III odds ratio, 4.0; 95% confidence interval, 2.9 to 5.5).

Conclusions: Selection bias exists with obese patients and ventral hernias. Emergent VHR have increased complications. Elective BMI cutoffs require re-evaluation.

Keywords: Emergent surgery; NSQIP; Obesity; Surgical site occurrences; Ventral hernia repair; Watchful waiting.