Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Risk Assessment Of Concurrent Panniculectomy With Open Ventral Hernia Repair_a Propensity Score-matched Analysis Using The 2005-2011 Acs-nsqip
John P. Fischer, MD, Charles T. Tuggles, MD, Ari M. Wes, BA, Stephen J. Kovach, III, MD.
University of Pennsylvania, Philadelphia, PA, USA.

Objective: Develop a model of risk assessment of concurrent panniculectomy (VHR-PAN) during ventral hernia repair (VHR).
Background: Recent studies have assessed the benefits and risks of performing concurrent PAN in the setting of hernia repair, gynecologic surgery, and oncologic resections with conflicting results. The aim of this study is to assess the added risk of VHR-PAN using the ACS-NSQIP data sets.
Methods: The 2005-2011 ACS-NSQIP databases were queried to identify all patients undergoing VHR alone or VHR-PAN. Current Procedural Terminology (CPT) codes were used to define hernia repairs and concurrent panniculectomies. Propensity scores were used to account for potential selection bias given the non-randomized assignment of concurrent panniculectomy and the retrospective nature of this study. Multivariate logistic regression analyses were used to assess the impact of concurrent PAN on wound complications, venous thromboembolism, unplanned reoperation, and medical complications.
Results: A total of 55,537 patients were identified. Propensity matching yielded two groups of patients: VHR (n=1,250) and VHR-PAN (n=1,250). Few statistically significant differences existed between matched cohorts and no significant differences in sociodemographic characteristics, clinical parameters, or comorbidities were noted. Matched analysis of obese patients showed significantly higher rates of surgical complications at BMI ranges of 30-34.9 kg/m2 (P=.001) and ≥50 kg/m2 (P=.034) in combined VHR-PAN (Figure 1). VHR-PAN was not associated with an increased risk of surgical complications in the intermediate BMI groups (35.0-39.9kg/m2) (P=.186) and (40.0-44.9kg/m2) (P=.535). Overall, wound complications (P<.001), venous thromboembolism (P=.044), rates of reoperation (P<.001), and medical morbidity (P<.001) were significantly higher in the VHR-PAN group. In an adjusted, fixed-effects analysis, concurrent panniculectomy was associated with wound healing complications (OR=1.69, P<.001), increased rates of unplanned reoperations (OR=2.08, P=<.001), venous thromboembolism (OR=2.48, P=.043), and overall medical morbidity (OR=2.08, P<.001) (Table 1).
Conclusions: This analysis quantifies the added risk of performing a panniculectomy concurrent with ventral hernia repair and demonstrates a relatively unfavorable risk profile for certain patient groups. A favorable risk-benefit was observed in the BMI range of 35.0-44.9 kg/m2. These data provide the foundation for a more comprehensive assessment of the risk-benefit of VHR-PAN and can be used to assist surgeons in informing patients and improving patient selection.



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