Impact of body mass index on minimally invasive ventral hernia repair: an ACS-NSQIP analysis

Abstract

Purpose: Body mass index (BMI) ≥ 35 kg/m² is a known independent risk factor for complications following open ventral hernia repair (VHR). We sought to examine the relationship between BMI and minimally invasive VHR.

Methods: The ACS-NSQIP database was queried for all patients age ≥ 18 years undergoing minimally invasive VHR (2005-2015). Patients were stratified into seven BMI classes: underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5-24.9), overweight (25-29.9), obese (30-34.5), severely obese (35-39.9), morbidly obese (40-49.9), and super obese (BMI ≥ 50), as well as by hernia type (reducible vs. strangulated) and time of repair (initial vs. recurrent). Multivariate logistic regression was employed to assess the risk of complication by BMI class.

Results: A total of 55,180 patients met inclusion criteria, and 61.4% had a BMI > 30 kg/m². When stratified by BMI class, we found significant differences in age, gender, race, comorbidities, and pre-operative characteristics across groups. The overall complication rate was 4.0%, ranging from 3.0% for normal BMI patients, to 6.9% for patients with a BMI ≥ 50 kg/m². Recurrent repairs and strangulated hernias both demonstrated higher complication rates. All complications (surgical and medical) were significantly associated with BMI class after adjustment (p < 0.0001). Patients with a BMI ≥ 50 kg/m² had a 1.4 times greater risk for complications than patients with normal BMIs (18-24.9 kg/m², p = 0.01).

Conclusion: BMI ≥ 50 kg/m² was determined to be an independent risk factor for surgical and medical complications after minimally invasive VHR.

Keywords: Body mass index; Laparoscopic hernia repair; NSQIP; Obesity; Obesity paradox.