Plastic Surgery Research Council
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INNOVATIVE ANALYTIC MORPHOMETRIC ASSESSMENT AND BODY COMPOSITION PREDICTS SURGICAL SITE INFECTION IN PATIENTS UNDERGOING COMPONENT SEPARATION VENTRAL HERNIA REPAIR
Presenter: Jeffrey L Lisiecki, ScB
Co-Authors: Levi B; Rinkinen JR; Terjimanian MN; Holcombe SA; Kozlow JH; Wang SC; Kuzon WM
University of Michigan Medical School

Objective: Obesity is a known risk factor for surgical site infection (SSI); however, we currently lack an objective methodology to predict this risk. Our hypothesis is that morphomic measures of subcutaneous fat and total body area obtained from routine pre-operative Computed Tomography (CT) scans is associated with increased risk of SSI and will predict SSI in patients undergoing ventral hernia repair (VHR) using a component separation technique.

Methods: We identified 111 patients who underwent component release VHR (2002 to 2011) using our clinical database. In all patients, the surgical technique involved musculofascial release of the external oblique muscle lateral to the linea semilunaris line. Using novel, semiautomated analytic morphomics, the subcutaneous fat area, total body area, vertebra to fascia distance and vertebra to skin distance along the linea alba was measured between T12 and L4 of the routine pre-operative CT scans. Logistic regression analyses were used to identify factors associated with the incidence of SSI, controlling for patient age, gender, and BMI.

Results: Overall, SSIs were observed in 35% (n =39) of the population. Pearson s correlation coefficients showed significant associations between several morphomic indices and the occurrence of SSI. Multivariate logistic regression revealed that those patients with larger vertebra to skin distance, larger vertebra to fascia distance, and larger subcutaneous fat area also had higher incidences of SSI (p=0.0369, p=0.0338, and p=0.0366 respectively; Figs 1-3, respectively), controlling for patient age, gender, and BMI. These morphomic measures proved to be better predictors of SSI incidence than BMI, which was not significantly correlated with SSI incidence (p=0.065).

Conclusion: Abdominal subcutaneous fat and body thickness serve as independent predictors of superficial incisional SSI after VHR. Novel morphometric measures obtained from already existing pre-operative CT scans may improve risk stratification and help elucidate the pathophysiology of surgical complications in patients undergoing component release repair of ventral hernias.


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