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Erschienen in: Hernia 1/2021

16.12.2019 | Original Article

Propensity score matching analysis of short-term outcomes in robotic ventral hernia repair for patients with a body mass index above and below 35 kg/m2

verfasst von: O. Y. Kudsi, F. Gokcal, K. Chang

Erschienen in: Hernia | Ausgabe 1/2021

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Abstract

Objective

The purpose of this study was to compare perioperative complications after robotic ventral hernia repair between patients with non-obese, class-I obesity with those with class-II or class-III obesity.

Background

Obesity is a growing epidemic and is considered as an independent risk factor for a multitude of perioperative complications. Laparoscopic ventral hernia repair has been shown as a safe and feasible approach in population with elevated body mass index (BMI). This study compared overall perioperative complications and surgical site events (SSEs) after robotic ventral hernia repair (RVHR) between patients with a BMI 35 kg/m2 or more and patients with a BMI lower than 35 kg/m2.

Methods

A retrospective cohort analysis was conducted with one-to-one propensity score matching (PSM) method to obtain balanced groups evaluating patients who underwent RVHR between February 2012 and June 2019 in a single institution. Preoperative, intraoperative, and postoperative variables were reviewed. Postoperative complications and morbidity were assessed using the Clavien–Dindo classification and comprehensive complication index (CCI®) score system. SSEs were compared.

Results

Our unmatched sample included 526 patients with an average BMI of 31.2 kg/m2. Of these, 29.8% (n = 160) patients were in high-BMI group (range 35–59.2). After PSM, 142 patients were assigned to each group. Both groups experienced similar complication rates during 90 days. Clavien–Dindo grades, CCI® scores, and SSEs did not differ between the two groups.

Conclusion

RVHR in class-II and class-III obese patients is safe, feasible, and effective. In addition to this, it has comparable short-term outcomes with those non-obese and class-I obese patients.
Literatur
1.
Zurück zum Zitat Blackstone RP, Epidemiology, measurement, and cost of obesity (2016) In: Obesity, Springer, pp 1-22 Blackstone RP, Epidemiology, measurement, and cost of obesity (2016) In: Obesity, Springer, pp 1-22
2.
Zurück zum Zitat Novitsky YW, Cobb WS, Kercher KW et al (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141:57–61CrossRef Novitsky YW, Cobb WS, Kercher KW et al (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141:57–61CrossRef
3.
Zurück zum Zitat Flancbaum L, Choban PS (1998) Surgical implications of obesity. Annu Rev Med 49:215–234CrossRef Flancbaum L, Choban PS (1998) Surgical implications of obesity. Annu Rev Med 49:215–234CrossRef
4.
Zurück zum Zitat Raftopoulos I, Courcoulas AP (2007) Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Surg Endosc 21:2293–2297CrossRef Raftopoulos I, Courcoulas AP (2007) Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Surg Endosc 21:2293–2297CrossRef
5.
Zurück zum Zitat Froylich D, Segal M, Weinstein A et al (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30:670–675CrossRef Froylich D, Segal M, Weinstein A et al (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30:670–675CrossRef
6.
Zurück zum Zitat Birgisson G, Park AE, Mastrangelo MJ Jr et al (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc 15:1419–1422CrossRef Birgisson G, Park AE, Mastrangelo MJ Jr et al (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc 15:1419–1422CrossRef
7.
Zurück zum Zitat Tsereteli Z, Pryor BA, Heniford BT et al (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12:233–238CrossRef Tsereteli Z, Pryor BA, Heniford BT et al (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12:233–238CrossRef
8.
Zurück zum Zitat Ching SS, Sarela AI, Dexter SP et al (2008) Comparison of early outcomes for laparoscopic ventral hernia repair between nonobese and morbidly obese patient populations. Surg Endosc 22:2244–2250CrossRef Ching SS, Sarela AI, Dexter SP et al (2008) Comparison of early outcomes for laparoscopic ventral hernia repair between nonobese and morbidly obese patient populations. Surg Endosc 22:2244–2250CrossRef
9.
Zurück zum Zitat Rosen MJ, Aydogdu K, Grafmiller K et al (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19:1399–1406CrossRef Rosen MJ, Aydogdu K, Grafmiller K et al (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19:1399–1406CrossRef
10.
Zurück zum Zitat Marx L, Raharimanantsoa M, Mandala S et al (2014) Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35. Surg Endosc 28:3310–3314CrossRef Marx L, Raharimanantsoa M, Mandala S et al (2014) Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35. Surg Endosc 28:3310–3314CrossRef
11.
Zurück zum Zitat Lindmark M, Strigard K, Lowenmark T et al (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42:3528–3536CrossRef Lindmark M, Strigard K, Lowenmark T et al (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42:3528–3536CrossRef
12.
Zurück zum Zitat Giordano SA, Garvey PB, Baumann DP et al (2017) the impact of body mass index on abdominal wall reconstruction outcomes: a comparative study. Plast Reconstr Surg 139:1234–1244CrossRef Giordano SA, Garvey PB, Baumann DP et al (2017) the impact of body mass index on abdominal wall reconstruction outcomes: a comparative study. Plast Reconstr Surg 139:1234–1244CrossRef
13.
Zurück zum Zitat von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies STROBE statement. Ann Intern Med 147:573–577CrossRef von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies STROBE statement. Ann Intern Med 147:573–577CrossRef
14.
Zurück zum Zitat Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414CrossRef Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414CrossRef
15.
Zurück zum Zitat Gokcal F, Morrison S, Kudsi OY (2019) Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair. Hernia 23:957–967CrossRef Gokcal F, Morrison S, Kudsi OY (2019) Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair. Hernia 23:957–967CrossRef
16.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef
17.
Zurück zum Zitat Slankamenac K, Graf R, Barkun J et al (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7CrossRef Slankamenac K, Graf R, Barkun J et al (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7CrossRef
18.
Zurück zum Zitat Petro CC, Novitsky YW (2016) Classification of hernias. In: hernia surgery, Springer, Berlin, pp 15–21 Petro CC, Novitsky YW (2016) Classification of hernias. In: hernia surgery, Springer, Berlin, pp 15–21
20.
Zurück zum Zitat Gokcal F, Morrison S, Kudsi OY (2019) Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications. Hernia 23:375–385CrossRef Gokcal F, Morrison S, Kudsi OY (2019) Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications. Hernia 23:375–385CrossRef
21.
Zurück zum Zitat Faul F, Erdfelder E, Lang AG et al (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRef Faul F, Erdfelder E, Lang AG et al (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRef
22.
Zurück zum Zitat Thoemmes F(2012) Propensity score matching in SPSS. Tubingen, University of Tubingen Thoemmes F(2012) Propensity score matching in SPSS. Tubingen, University of Tubingen
23.
Zurück zum Zitat Hansen BB, Bowers J (2008) Covariate balance in simple, stratified and clustered comparative studies. Stat Sci 23:219–236CrossRef Hansen BB, Bowers J (2008) Covariate balance in simple, stratified and clustered comparative studies. Stat Sci 23:219–236CrossRef
24.
Zurück zum Zitat Iacus S, King G, Porro G (2009) CEM: Software for coarsened exact matching. J Stat Softw 30:1–27CrossRef Iacus S, King G, Porro G (2009) CEM: Software for coarsened exact matching. J Stat Softw 30:1–27CrossRef
25.
Zurück zum Zitat Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89CrossRef Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89CrossRef
26.
Zurück zum Zitat Tastaldi L, Krpata DM, Prabhu AS et al (2019) The effect of increasing body mass index on wound complications in open ventral hernia repair with mesh. Am J Surg 218:560–566CrossRef Tastaldi L, Krpata DM, Prabhu AS et al (2019) The effect of increasing body mass index on wound complications in open ventral hernia repair with mesh. Am J Surg 218:560–566CrossRef
27.
Zurück zum Zitat Kaoutzanis C, Leichtle SW, Mouawad NJ et al (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123CrossRef Kaoutzanis C, Leichtle SW, Mouawad NJ et al (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123CrossRef
28.
Zurück zum Zitat Mrdutt MM, Munoz-Maldonado Y, Regner JL (2016) Impact of obesity on postoperative 30-day outcomes in emergent open ventral hernia repairs. Am J Surg 212:1068–1075CrossRef Mrdutt MM, Munoz-Maldonado Y, Regner JL (2016) Impact of obesity on postoperative 30-day outcomes in emergent open ventral hernia repairs. Am J Surg 212:1068–1075CrossRef
29.
Zurück zum Zitat Regner JL, Mrdutt MM, Munoz-Maldonado Y (2015) Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes. Am J Surg 210:1024–1029CrossRef Regner JL, Mrdutt MM, Munoz-Maldonado Y (2015) Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes. Am J Surg 210:1024–1029CrossRef
30.
Zurück zum Zitat Owei L, Swendiman RA, Kelz RR et al (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surgery 162:1320–1329CrossRef Owei L, Swendiman RA, Kelz RR et al (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surgery 162:1320–1329CrossRef
31.
Zurück zum Zitat Pernar LIM, Pernar CH, Dieffenbach BV et al (2017) What is the BMI threshold for open ventral hernia repair? Surg Endosc 31:1311–1317CrossRef Pernar LIM, Pernar CH, Dieffenbach BV et al (2017) What is the BMI threshold for open ventral hernia repair? Surg Endosc 31:1311–1317CrossRef
32.
Zurück zum Zitat Sauerland S, Walgenbach M, Habermalz B, et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev: CD007781 Sauerland S, Walgenbach M, Habermalz B, et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev: CD007781
33.
Zurück zum Zitat Alfalah H, Philippe B, Ghazal F et al (2006) Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity. Obes Surg 16:147–150CrossRef Alfalah H, Philippe B, Ghazal F et al (2006) Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity. Obes Surg 16:147–150CrossRef
34.
Zurück zum Zitat Robinson SP, Hirtle M, Imbrie JZ et al (1998) The mechanics underlying laparoscopic intra-abdominal surgery for obese patients. J Laparoendosc Adv Surg Tech A 8:11–18CrossRef Robinson SP, Hirtle M, Imbrie JZ et al (1998) The mechanics underlying laparoscopic intra-abdominal surgery for obese patients. J Laparoendosc Adv Surg Tech A 8:11–18CrossRef
35.
Zurück zum Zitat Carbonell AM, Warren JA, Prabhu AS et al (2018) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg 267:210–217CrossRef Carbonell AM, Warren JA, Prabhu AS et al (2018) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg 267:210–217CrossRef
36.
Zurück zum Zitat Warren JA, Cobb WS, Ewing JA et al (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332CrossRef Warren JA, Cobb WS, Ewing JA et al (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332CrossRef
Metadaten
Titel
Propensity score matching analysis of short-term outcomes in robotic ventral hernia repair for patients with a body mass index above and below 35 kg/m2
verfasst von
O. Y. Kudsi
F. Gokcal
K. Chang
Publikationsdatum
16.12.2019
Verlag
Springer Paris
Erschienen in
Hernia / Ausgabe 1/2021
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-019-02108-2

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