Pernar Luise I M, Pernar Claire H, Dieffenbach Bryan V, Brooks David C, Smink Douglas S, Tavakkoli Ali
Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Surg Endosc. 2017 Mar;31(3):1311-1317. doi: 10.1007/s00464-016-5113-5. Epub 2016 Jul 20.
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.
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 (25-29.99 kg/m); 3 (30-34.99 kg/m); 4 (35-39.99 kg/m); and 5 (≥40 kg/m). Multivariable, adjusted logistic regression was performed to evaluate the association between BMI categories and postoperative complications.
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).
After VHR, complications are most likely to occur in patients with BMI ≥ 40 kg/m. 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.
超重和肥胖患者在接受腹疝修补术（VHR）前常被要求减重。改善预后是这一策略背后的原因。关于减重目标的数据很少，而且尚不清楚体重指数（BMI）达到何种阈值时术后并发症会增加。本研究旨在确定一个阈值，以便为患者提供恰当的咨询。
纳入2002年至2015年期间在我们机构接受开放性VHR且被纳入NSQIP数据库的所有患者。主要结局定义为所记录的18种术后并发症中的任何一种（≥1种）。患者根据BMI分为五组：第1组（<25kg/m²）；第2组（25 - 29.99kg/m²）；第3组（30 - 34.99kg/m²）；第4组（35 - 39.99kg/m²）；第5组（≥40kg/m²）。进行多变量校正逻辑回归以评估BMI类别与术后并发症之间的关联。
922例患者中有67例（7.3%）在VHR后至少发生了一种术后并发症。第5组并发症的校正比值比相比第1组高2.89倍（比值比2.89；95%置信区间 = 1.22 - 6.84），而第2、3或4组与第1组相比，术后并发症的比值比无显著差异。BMI类别也与再次进行VHR显著相关，第5组中有28.7%的患者进行了复发修补，而第1组中患者的这一比例为14%（p = 0.03）。
VHR后，BMI≥40kg/m²的患者最有可能发生并发症。这一亚组患者再次进行疝修补手术的风险也显著更高，表明这组患者在VHR后可能会出现不良结局，应建议他们在尝试VHR之前考虑进行减重手术。较低BMI时进行VHR似乎是合适的，延迟治疗以实现术前减重可能并无益处。
