Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study

Ross, Samuel W.; Wormer, Blair A.; Kim, Mimi; Oommen, Bindhu; Bradley, Joel F.; Lincourt, Amy E.; Augenstein, Vedra A.; Heniford, B. Todd

doi:10.1016/j.amjsurg.2015.06.020

Cited by 32 publications

(19 citation statements)

References 39 publications

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“…Although patients with an IH had a decreased level of HRQoL regarding emotional and physical roles, the low incidence of IH in this selected and small cohort does not support an indication for implanting a prophylactic mesh at time of CRS + HIPEC. The extensive CRS + HIPEC procedure results in a massive scar, which increases the risk of infection and complications when implanting a mesh [ 32 ]. This should especially be taken into consideration in cohorts with a reduced progression-free survival time [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study

et al. 2018

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BackgroundTo evaluate the incidence of incisional hernia (IH) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) and its impact on health-related quality of life (HRQoL).MethodFrom June 2006 until June 2016, 152 patients were followed after CRS + HIPEC at Aarhus University Hospital, a single national center. Patients were seen postoperatively in an outpatient clinic at 3, 6, 12, 18, 24, 36 48, and 60 months. Clinical examinations at these follow-up visits were used to evaluate IH events prospectively. The incidence of IH was estimated using competing risk analysis and is presented as the cumulative incidence proportion (CIP). We expected the incidence to be 15% at 12 months. HRQoL was assessed at 12 months by the Short Form (SF-36) questionnaire, which we used to compare patients with an IH to patients without an IH.ResultsThe median follow-up time was 16.6 months [range 0.9–62.0]. During this period, 14/152 (9.2%) patients developed an IH. The 1-year CIP was 5.9% [95% CI 2.9; 10.4] (n = 8), and the 2-year CIP was 9.2% [95% CI 5.3; 14.5] (n = 14). Patients with an IH were significantly older (67 years [range 48–72]) compared to patients without IH (60 years [range 24–75], p ≤ 0.01). The rate of postoperative complications between patients with and without IH was comparable, except that a greater proportion of patients with IH had a fascial dehiscence (21.4%) compared to patients without an IH (3.6%). Reponses to the SF-36 show that patients with an IH report lower HRQoL with regard to Role-physical (mean difference − 32.9 [95% CI − 60.6; − 5.3]) and Role-emotional (mean difference − 20.2 [95% CI − 43.4; 3.1]), meaning a reduction in work and daily activities due to their physical and psychological health. We found no general decrease in HRQoL.ConclusionCRS + HIPEC do not increase the risk of IH as measured within 12 months postoperatively, contrary to expectations. However, patients with an IH report a limitation in daily activities, which can best be explained by changes in physical and psychological health. A larger cohort from multiple centres is necessary to verify our findings.

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Section: Discussionmentioning

confidence: 99%

Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study

et al. 2018

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“…At present it is not possible to determine which patients will benefit most from surgical hernia repair and many aspects must be considered before deciding on surgery. Important aspects include the risk for serious adverse effects emanating from synthetic reinforcement material, abdominal pain after surgery, and other risks related to anaesthesia and surgery [ 15 ]. It is thus of paramount importance to assess patient satisfaction using, for instance, a questionnaire as one PROM regarding pain related to function [ 14 – 16 ] as well as objective functional measurements such as muscle strength measured by the BioDex system before deciding on surgery.…”

Section: Discussionmentioning

confidence: 99%

Giant ventral hernia—relationship between abdominal wall muscle strength and hernia area

et al. 2016

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BackgroundSymptoms arising from giant ventral hernia have been considered to be related to weakening of the abdominal muscles. The aim of this study was to investigate the relationship between the area of the abdominal wall defect and abdominal wall muscle strength measured by the validated BioDex system together with a back/abdominal unit.MethodsFifty-two patients with giant ventral hernia (>10 cm wide) underwent CT scan, clinical measurement of hernia size and BioDex measurement of muscle strength prior to surgery. The areas of the hernia derived from CT scan and from clinical measurement were compared with BioDex forces in the modalities extension, flexion and isometric contraction. The Spearman rank test was used to calculate correlations between area, BMI, gender, age, and muscle strength.ResultThe hernia area calculated from clinical measurements correlated to abdominal muscle strength measured with the Biodex for all modalities (p-values 0.015–0.036), whereas no correlation was seen with the area calculated by CT scan. No relationship was seen between BMI, gender, age and the area of the hernia.DiscussionThe inverse correlation between BioDex abdominal muscle strength and clinically assessed hernia area, seen in all modalities, was so robust that it seems safe to conclude that the area of the hernia is an important determinant of the degree of loss of abdominal muscle strength. Results using hernia area calculated from the CT scan showed no such correlation and this would seem to concur with the results from a previous study by our group on patients with abdominal rectus diastasis. In that study, defect size assessed clinically, but not that measured by CT scan, was in agreement with the size of the diastasis measured intra-operatively.The point at which the area of a hernia begins to correlate with loss of abdominal wall muscle strength remains unknown since this study only included giant ventral hernias.

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“…to significantly worsen patient quality of life, require longer lengths of stay, and result in higher hospital and discharge costs. 1,2 Similar complications have been shown to be increased in emergency general surgery (EGS) patients, who have been shown to have mortality rates that are up to six times higher than their elective counterparts. 3 However, little is known about SSI risk in EGS cases, but they are likely to have many well-described risks for the development of SSI.…”

Section: S Urgical Site Infections Have Been Demonstratedmentioning

confidence: 95%

“…SSIs are one complication that causes a great deal of detriment to patients and their quality of life postoperatively not only because of the patients' ready ability to see the complication at the skin but also because of subsequent multiple possible procedures, need for antibiotics, financial impact, future hernia formation risk, and poor scar cosmesis, to name just a few. 1,2 Therefore, the aim of our study was to quantify the increased risk of SSI in EGS cases that had readily available elective counterparts. We hypothesized that emergency cases have a higher rate of postoperative SSI than the same elective procedures.…”

Section: S Urgical Site Infections Have Been Demonstratedmentioning

confidence: 99%

Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP

Arnold

Kao

Cunningham

et al. 2019

The American Surgeon™

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Emergent surgeries have different causes and physiologic patient responses than the same elective surgery, many of which are due to infectious etiologies. Therefore, we hypothesized that emergency cases have a higher risk of postoperative SSI than their elective counterparts. The ACS NSQIP database was queried from 2005 to 2016 for all cholecystectomies, ventral hernia repairs, and partial colectomies to examine common emergency and elective general surgery operations. Thirty-day outcomes were compared by emergent status. Any SSI was the primary outcome. There were 863,164 surgeries: 416,497 cholecystectomies, 220,815 ventral hernia repairs, and 225,852 partial colectomies. SSIs developed in 38,865 (4.5%) patients. SSIs increased with emergencies (5.3% vs 3.6% for any SSI). Postoperative sepsis (5.8% vs 1.5%), septic shock (4.7% vs 0.6%), length of stay (8.1 vs 2.9 days), and mortality (3.6% vs 0.4%) were increased in emergent surgery; P < 0.001 for all. When controlling for age, gender, BMI, diabetes, smoking, wound classification, comorbidities, functional status, and procedure on multivariate analysis, emergency surgery (odds ratio 1.15, 95% confidence interval 1.11–1.19) was independently associated with the development of SSI. Patients undergoing emergency general surgery experience increased rates of SSI. Patients and their families should be appropriately counseled regarding these elevated risks when consenting for emergency surgery.

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Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study

Cited by 32 publications

References 39 publications

Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study

Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study

Giant ventral hernia—relationship between abdominal wall muscle strength and hernia area

Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP

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