Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel -Aviv University, Tel Aviv, Israel.
Hernia. 2024 Dec;28(6):2291-2300. doi: 10.1007/s10029-024-03161-2. Epub 2024 Sep 13.
Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR).
We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: "Optimal GC" (HbA1c < 7%), "Sub-optimal GC" (HbA1c 7-8.4%), and "Poor GC" (HbA1c ≥ 8.5%) and their outcomes were compared.
514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented.
In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.
大量研究表明，糖尿病（DM）是术后伤口发病率的重要危险因素，术前血糖控制不佳（GC）的风险更大。然而，这些数据在很大程度上排除了腹疝患者。我们的研究检查了糖尿病与术前 GC 以及开放式复杂腹壁重建（AWR）后术后结果之间的关系。
我们确定了在克利夫兰诊所基金会接受过开放式、择期、清洁 VHR 并伴有腹横肌释放（TAR）和永久性合成网片的糖尿病患者，时间为 2014 年 1 月至 2023 年 12 月。将他们的 30 天结果与接受相同手术的非糖尿病患者进行比较。随后，根据 GC 状态对糖尿病患者进行分类：“最佳 GC”（HbA1c<7%）、“次佳 GC”（HbA1c7-8.4%）和“不佳 GC”（HbA1c≥8.5%），并比较他们的结果。
确定了 514 例接受清洁择期 TAR 的糖尿病患者，其中 431 例符合纳入标准。255 例患者的 GC 被认为是最佳的，128 例是次佳的，48 例是不佳的。除了抗凝治疗（p=0.014）外，两组患者的人口统计学特征相似。整个研究人群的伤口发病率和总体并发症发生率明显高于非糖尿病患者。然而，三组术前血糖控制的手术部位感染（SSI）、手术部位发生（SSO）、需要手术干预的 SSO（SSOPI）和再次手术率没有显著差异（p=0.82、p=0.46、p=0.51、p=0.78）。没有记录到网片移除。
一般来说，糖尿病是复杂腹壁重建后伤口发病率和并发症增加的标志。然而，我们不能根据任意 HbA1C 水平确定一个硬性截止值来证明在有症状的患者中拒绝手术是合理的。我们认为，对于有症状的腹疝糖尿病患者，考虑进行 AWR 时，这一数据对于共同决策很重要。
