No abstract

BackgroundComplex abdominal wall defects are important conditions with a high morbidity, leading to impairment of patients physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on transverse abdominis release (TAR) procedure.MethodsA retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedure between January 2014 – December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) was performed.Results50 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 Kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5 % ± 14.5%. Protective association was established for SSI if the procedure was performed by the AWRG OR 0.7 (IC 95% 0.05-0.93 ). Higher risk of SSI was found in cases not performed by the abdominal wall reconstruction group OR 13.6 (CI 95% 9.12 - 15.5 ). ConclusionsTAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups lessen surgical site infection.

within 7 days of their outpatient surgeries and asked what they had used for postoperative pain control. If narcotics were used, they were asked if they felt they received too many, just enough, or not enough pills. We also inquired how many tablets the patient had left and how many they had used. We then retrospectively reviewed this data. RESULTS:In 2017, seven divisions (General, Vascular, Plastics, Neurosurgery, Cardiac, ENT, and Urology) chose two procedures each to review. For example, the General Surgery division agreed to a standard of 15 opioid tablets as an initial postoperative prescription following laparoscopic cholecystectomy. For all procedures, providers prescribed 10.2 AE 14.8 tablets of hydrocodone-acetaminophen less than the agreed upon standardization. Starting in 2020, 429 patients who underwent these procedures were queried as to their postoperative pain control. On average, 91 + 0.2% of patients were prescribed opioids, while 70 AE 0.3% of patients actually used them by postoperative day 2. CONCLUSION: Our project demonstrates that despite reducing postoperative opioid prescribing across a variety of surgical subspecialties, patients used less narcotics than prescribed.