Plastic Surgery Research Council
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MAJOR SURGICAL AND RESPIRATORY COMPLICATIONS FOLLOWING COMPLEX ABDOMINAL WALL RECONSTRUCTION AN ANALYSIS OF 1,102 HERNIA REPAIRS WITH COMPONENT SEPARATION FROM NSQIP DATASET
Presenter: John P Fischer, Resident
Co-Authors: Nelson JN; Nelson JA
University of Pennsylvania

Background: Complex abdominal wall reconstruction often requires component separation to achieve fascial approximation. Such reconstructions can be associated significant rates of surgical complications and respiratory events. We aim to characterize outcomes after abdominal wall reconstruction using the ACS-NSQIP database.

Methods: We reviewed the 2006-2010 ACS-NSQIP databases identifying encounters for both hernia repair and component separation. Major surgical complications were a return to OR or a deep wound infection and respiratory complication were an unplanned intubation or failure to wean (>48 hrs). Exploratory univariate analyses were performed and regression analyses were used to identify predictors.

Results: 1,102 complex repairs were performed with an average length of stay of 6.5 days. Complications included: wound (14%), major surgical (12%), and respiratory (8%). The following factors were significantly associated with major surgical complications in univariate analysis: age, obesity, diabetes, smoking, dyspnea, COPD, steroid use, emergency, preoperative albumin, contaminated wounds, ASA>3, and operative time. Patients experiencing major surgical complications stayed for 5.5 days longer. Independent predictors of surgical complications are summarized in Table 1. The following factors were significantly associated with respiratory complications: age, resident involvement, obesity, diabetes, smoking, dyspnea, functional status, COPD, CHF, weight loss, albumin, malnutrition, wound class, ASA, and operative time. Patients experiencing a respiratory complication stayed 10.8 days longer. Independent predictors of respiratory complications are summarized in Table 1.

Discussion: Major surgical complications add 6 hospital days and are associated with age, smoking, steroid use, and operative time. Respiratory complications on average add 11 hospital days and are associated with obesity, functional and nutritional status, ASA score, and operative time. Data derived from this large cohort can be used to risk-stratify patients and to enhance preoperative discussions.


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