The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience
- 13.09.2024
- Original Article
Erschienen in:
- Verfasst von
- Nir Messer
- Benjamin T. Miller
- Lucas R.A. Beffa
- Clayton C. Petro
- David M. Krpata
- Serrgio Mazzola Poli de Figueiredo
- Aldo Fafaj
- Li-Ching Huang
- Ryan C. Ellis
- Sara M. Maskal
- Ajita S. Prabhu
- Michael J. Rosen
- Erschienen in
- Hernia | Ausgabe 6/2024
Abstract
Introduction
Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR).
Methods
We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: “Optimal GC” (HbA1c < 7%), “Sub-optimal GC” (HbA1c 7-8.4%), and “Poor GC” (HbA1c ≥ 8.5%) and their outcomes were compared.
Results
514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented.
Conclusion
In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.
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- Titel
- The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience
- Verfasst von
-
Nir Messer
Benjamin T. Miller
Lucas R.A. Beffa
Clayton C. Petro
David M. Krpata
Serrgio Mazzola Poli de Figueiredo
Aldo Fafaj
Li-Ching Huang
Ryan C. Ellis
Sara M. Maskal
Ajita S. Prabhu
Michael J. Rosen
- Publikationsdatum
- 13.09.2024
- Verlag
- Springer Paris
- Erschienen in
-
Hernia / Ausgabe 6/2024
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204 - DOI
- https://doi.org/10.1007/s10029-024-03161-2
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