Lee C, Ebrahimian S, Mabeza R M, Tran Z, Hadaya J, Benharash P, Moazzez A
Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Hernia. 2023 Oct;27(5):1095-1102. doi: 10.1007/s10029-023-02773-4. Epub 2023 Apr 19.
Although groin hernia repairs are relatively safe, efforts to identify factors associated with greater morbidity and resource utilization following these operations are warranted. An emphasis on obesity has limited studies from a comprehensive evaluation of the association between body mass index (BMI) and outcomes following groin hernia repair. Thus, we aimed to ascertain the association between BMI class with 30-day outcomes following these operations.
The 2014-2020 National Surgical Quality Improvement Program database was queried to identify adults undergoing non-recurrent groin hernia repair. Patient BMI was used to stratify patients into six groups: underweight, normal, overweight, and obesity classes I-III. Association of BMI with major adverse events (MAE), wound complication, and prolonged length of stay (pLOS) as well as 30-day readmission and reoperation were evaluated using multivariable regressions.
Of the 163,373 adults who underwent groin hernia repair, the majority of patients were considered overweight (44.4%). Underweight patients more commonly underwent emergent operations and femoral hernia repair compared to others. After adjustment of intergoup differences, obesity class III was associated with greater odds of an MAE (AOR 1.50), wound complication (AOR 4.30), pLOS (AOR 1.40), and 30-day readmission (AOR 1.50) and reoperation (AOR 1.75, all p < 0.05). Underweight BMI portended greater odds of pLOS and unplanned readmission.
Consideration of BMI in patients requiring groin hernia repair could help inform perioperative expectations. Preoperative optimization and deployment of a minimally invasive approach when feasible may further reduce morbidity in patients at the extremes of the BMI spectrum.
尽管腹股沟疝修补术相对安全，但仍有必要努力确定与这些手术后更高发病率和资源利用相关的因素。对肥胖的关注限制了对体重指数（BMI）与腹股沟疝修补术后结局之间关联的全面评估研究。因此，我们旨在确定BMI类别与这些手术后30天结局之间的关联。
查询2014 - 2020年国家外科质量改进计划数据库，以识别接受非复发性腹股沟疝修补术的成年人。患者BMI用于将患者分为六组：体重过轻、正常、超重以及肥胖I - III级。使用多变量回归评估BMI与主要不良事件（MAE）、伤口并发症、住院时间延长（pLOS）以及30天再入院和再次手术之间的关联。
在163,373例接受腹股沟疝修补术的成年人中，大多数患者被认为超重（44.4%）。与其他患者相比，体重过轻的患者更常接受急诊手术和股疝修补术。在调整组间差异后，肥胖III级与MAE（调整后比值比[AOR] 1.50）、伤口并发症（AOR 4.30）、pLOS（AOR 1.40）、30天再入院（AOR 1.50）和再次手术（AOR 1.75，所有p < 0.05）的更高几率相关。体重过轻的BMI预示着pLOS和计划外再入院的几率更高。
在需要腹股沟疝修补术的患者中考虑BMI有助于告知围手术期预期。术前优化并在可行时采用微创方法可能进一步降低BMI范围两端患者的发病率。
