Safety of open ventral hernia repair in high-risk patients with metabolic syndrome: a multi-institutional analysis of 39,118 cases

Dmitry Zavlin, Kevin T. Jubbal, Jeffrey L. Van Eps, Barbara L. Bass, Warren A. Ellsworth, Anthony Echo, Jeffrey D. Friedman, Brian J. Dunkin

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background: Metabolic syndrome (MetS) entails the simultaneous presence of a constellation of dangerous risk factors including obesity, diabetes, hypertension, and dyslipidemia. The prevalence of MetS in Western society continues to rise and implies an elevated risk for surgical complications and/or poor surgical outcomes within the affected population. Objective: To assess the risks and outcomes of multi-morbid patients with MetS undergoing open ventral hernia repair. Setting: Multi-institutional case-control study in the United States. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was sampled for patients undergoing initial open ventral hernia repair from 2012 through 2014 and then stratified into 2 cohorts based on the presence or absence of MetS. Statistical analyses were performed to evaluate preoperative co-morbidities, intraoperative details, and postoperative morbidity and mortality to identify risk factors for adverse outcomes. Results: Mean age (61.0 versus 56.0 yr, P<.001), body mass index (39.2 versus 31.1, P<.001), and prevalence of co-morbidities of multiple organ systems were significantly higher (P<.001) in the MetS cohort compared to control. Patients with MetS received higher American Society of Anesthesiologists classifications (81.0% versus 43.1% class 3 or higher, P<.001), were more likely to require operation as emergency cases (11.4% versus 7.2%, P<.001), required longer operative times (103 versus 87 min, P<.001), had longer hospitalizations (3.5 versus 2.4 d, P<.001), and had more contaminated wounds (15.9% versus 12.0% class 2 or higher, P<.001). Overall, they had more medical (7.5% versus 4.2%, P<.001), and surgical complications (9.7% versus 5.4%, P<.001), experienced more readmissions (8.3% versus 5.7%, P<.001) and reoperations (3.4% versus 2.5%, P<.001), and were at higher risk for eventual death (.8% versus.5%, P=.008). Conclusions: The presence of MetS is related to a multitude of unfavorable outcomes and increased mortality after open ventral hernia repair compared with a non-MetS control group. MetS is a useful marker for high operative risk in a population that is generally prone to obesity and its associated diseases.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalSurgery for Obesity and Related Diseases
Volume14
Issue number2
DOIs
StatePublished - Feb 2018

Keywords

  • Metabolic syndrome
  • Obesity
  • Outcomes
  • Risk factors
  • Secondary procedures
  • Ventral hernia repair

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    Zavlin, D., Jubbal, K. T., Van Eps, J. L., Bass, B. L., Ellsworth, W. A., Echo, A., Friedman, J. D., & Dunkin, B. J. (2018). Safety of open ventral hernia repair in high-risk patients with metabolic syndrome: a multi-institutional analysis of 39,118 cases. Surgery for Obesity and Related Diseases, 14(2), 206-213. https://doi.org/10.1016/j.soard.2017.09.521