Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH.
Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH.
Surgery. 2024 Mar;175(3):806-812. doi: 10.1016/j.surg.2023.07.031. Epub 2023 Sep 21.
Morbid obesity, with a body mass index 35 kg/m, is a commonly used cutoff for denying elective transversus abdominis release. Although obesity is linked to short-term wound morbidity, its effect on long-term outcomes remains unknown, calling into question if a cutoff is justified. We sought to compare 1-year recurrence rates after transversus abdominis release based on body mass index and to evaluate short- and long-term outcomes.
Patients undergoing open, clean transversus abdominis release from August 2014 to January 2022 at our institution with 1-year follow-up completed were identified. Univariate and multivariable analyses were performed to determine the association of body mass index with 90-day wound events, 1-year hernia recurrence, and hernia-specific quality of life. Covariates included body mass index, diabetes, recurrent hernia, hernia width, fascial closure, surgical site occurrence requiring procedural intervention, previous abdominal wall surgical site infection, inflammatory bowel disease, mesh weight, and mesh-to-hernia size ratio.
A total of 1,089 patients were included. Increasing body mass index was associated with surgical site infection (adjusted odds ratio = 1.59; 95% confidence interval, 1.14-1.77; P < .01) and surgical site occurrence (adjusted odds ratio = 1.42; 95% confidence interval, 1.13-1.74; P < .01) but was not associated with surgical site occurrence requiring procedural intervention. Hernia width was associated with surgical site occurrence (adjusted odds ratio = 1.4; 95% confidence interval, 1.08-1.82; P < .01) and surgical site occurrence requiring procedural intervention (adjusted odds ratio = 1.4; 95% confidence interval, 1.08-1.82; P = .01). Hernia recurrence rate at 1 year was lower for the body mass index ≥35 kg/m group (7% vs 12%; P = .02). Hernia width (odds ratio = 1.33; 95% confidence interval, 1.02-1.74; P = .04) was associated with recurrence; body mass index was not (P = .11). Both groups experienced significant improvement in hernia-specific quality of life at 1 year.
Morbid obesity is associated with 90-day wound morbidity; however, short-term complications did not translate to higher reoperation or long-term recurrence rates. The impact of body mass index on hernia recurrence is likely overstated. An arbitrary body mass index cutoff of 35 kg/m should not be used to deny symptomatic patients abdominal wall reconstruction.
病态肥胖，体重指数为 35kg/m²，是拒绝选择性腹横肌松解术的常用截止值。尽管肥胖与短期伤口发病率有关，但它对长期结果的影响尚不清楚，这就提出了是否应该使用截止值的问题。我们旨在比较根据体重指数进行腹横肌松解术后 1 年的复发率，并评估短期和长期结果。
我们确定了 2014 年 8 月至 2022 年 1 月期间在我们机构接受开放性、清洁腹横肌松解术且完成了 1 年随访的患者。进行了单变量和多变量分析，以确定体重指数与 90 天伤口事件、1 年疝复发和疝特异性生活质量之间的关联。协变量包括体重指数、糖尿病、复发性疝、疝宽度、筋膜闭合、需要手术干预的手术部位发生、先前的腹壁手术部位感染、炎症性肠病、网片重量和网片与疝的大小比。
共纳入 1089 例患者。体重指数的增加与手术部位感染（调整后的优势比=1.59；95%置信区间，1.14-1.77；P<.01）和手术部位发生（调整后的优势比=1.42；95%置信区间，1.13-1.74；P<.01）相关，但与需要手术干预的手术部位发生无关。疝宽度与手术部位发生（调整后的优势比=1.4；95%置信区间，1.08-1.82；P<.01）和需要手术干预的手术部位发生（调整后的优势比=1.4；95%置信区间，1.08-1.82；P=.01）相关。1 年时疝复发率在体重指数≥35kg/m²组较低（7%比 12%；P=.02）。疝宽度（比值比=1.33；95%置信区间，1.02-1.74；P=.04）与复发相关；体重指数则没有（P=.11）。两组患者在 1 年时疝特异性生活质量均显著改善。
病态肥胖与 90 天伤口发病率有关；然而，短期并发症并未转化为更高的再次手术或长期复发率。体重指数对疝复发的影响可能被夸大了。35kg/m²的任意体重指数截止值不应用于拒绝有症状的患者腹壁重建。
