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Surgery. 2019 Jul;166(1):94-101. doi: 10.1016/j.surg.2019.03.011. Epub 2019 May 13.

Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair.

Author information

1
Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH. Electronic address: alkhath2@ccf.org.
2
Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
3
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.

Abstract

BACKGROUND:

We aimed to assess the impact of modifiable comorbidities-obesity, diabetes, and smoking-and their aggregate effect on wound complications after incisional hernia repair.

METHODS:

Data on all open, elective, incisional hernia repair with permanent synthetic mesh in clean wounds were collected from the Americas Hernia Society Quality Collaborative and reviewed. Three groups were defined: those with 0, 1, or 2+ modifiable comorbidities, with associations described for each specific comorbid condition. Primary outcomes included surgical site occurrences, surgical site infections, and surgical site occurrences requiring procedural intervention.

RESULTS:

A total of 3,908 subjects met the inclusion criteria. Mean hernia width was 9.6 ± 6.5 cm, mean body mass index was 32.1 ± 6.6 kg/m2, 21% of patients had diabetes, and 9% were smokers. Of those, 31% had no modifiable comorbidities, 49% had 1 modifiable comorbidity, and 20% had 2+ modifiable comorbidities. Compared with having no modifiable comorbidities, having 1 modifiable comorbidity, or 2+ modifiable comorbidities significantly increased the odds of a surgical site occurrence (odds ratios 1.33 and 1.61, respectively). However, only patients with 2+ modifiable comorbidities had significantly increased odds of surgical site occurrences requiring procedural intervention compared with no modifiable comorbidities and 1 modifiable comorbidity (odds ratios 2.02 and 1.65, respectively). Patients with all 3 comorbidities had a two-fold increase in odds for all wound morbidity, followed similarly by obese patients with diabetes.

CONCLUSION:

The presence of any number of comorbidities (1 modifiable comorbidity or 2+ modifiable comorbidities) increases the odds for wound events. However, having multiple comorbidities was associated with more procedural interventions for wound management. This was most evident in patients with all 3 comorbidities, and, in obese diabetics, underscoring the importance of preoperative counseling on expected recovery in such patients.

PMID:
31097319
DOI:
10.1016/j.surg.2019.03.011

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