Risk Factors For Severe Adverse Outcomes In VHR
According to an abstract in the September 2009 issue of the supplement to the Journal of the American College of Surgeons, ventral hernia repair (VHR) has been identified as one of 10 general surgery procedures responsible for over half of complications and extended hospital stays.
The researchers included Brook V Nelson MD, Fengming Tang MS, Philip Jones MS, John Spertus MD, MPH and Kimberly Brown MD, of the University of Missouri-Kansas City, St. Luke’s Hospital, Kansas City, MO. They set out to identify preoperative risk factors for severe adverse outcomes (SAR) with the goal of allowing appropriate counseling for risk factor modification or nonoperative management.
Using the ACS NSQIP data set from 2005-2007, the researchers identified patients who underwent a VHR procedure at more than 121 hospitals. They compared 50 preoperative characteristics between patients with and without SAR at 30 days. Using multivariable logistic regressions, they were able to identify key risk factors for SAR in the procedure.
Of 16,226 VHR patients identified in the study, 1,236 (7 percent) had SAR. Of the patients with SAR, the outcomes represented were as follows:
- 5 percent—death
- 52 percent—wound infection
- 37 percent—return to the OR
- 18.7 percent—sepsis
- 14.1 percent—ventilator requirement of greater than 48 hours
- 13.3 percent—pneumonia
- 12.4 percent—unplanned intubation
- 10.9 percent—septic shock
- 5.6 percent—dehiscence
- 3.4 percent—acute renal failure
- 2.6 percent—cardiac arrest requiring CPR.
- 1.9 percent—requirement of blood transfusion
- 1.4 percent—prosthesis failure
- 0.2 percent—myocardial infarction
Based on multivariable analysis, the researchers cited significant factors associated with SAR in patients, including:
- Open wounds or ongoing wound infections
- Poor functional status
- BMI greater than 35
- Recent prior operation
- Greater than 10 percent recent weight loss
- Recurrent hernia
In the end, the researchers concluded that patients who smoke, have a BMI greater than 35, have undergone a greater than 10 percent loss of weight, dyspnea and nonindependent functional status are at greatest risk for SAR in a VHR procedure. They advise that these patients be targeted for preoperative optimization to prevent SAR, and that older patients or those with a recurrent hernia, ongoing wound infections, recent surgery or who require emergency procedures should be counseled appropriately.
Source: Supplement to the Journal of the American College of Surgeons, Sept.2009