Use of morphometric assessment of body composition to quantify risk of surgical-site infection in patients undergoing component separation ventral hernia repair

Plast Reconstr Surg. 2014 Apr;133(4):559e-566e. doi: 10.1097/PRS.0000000000000009.


Background: Body mass index does not allow accurate risk stratification for individuals undergoing component separation repair of ventral hernias. The authors hypothesized that tissue morphology measurements (morphomics) of preoperative computed tomography scans stratify the risk of surgical site infection in patients undergoing ventral hernia repair with a component separation technique.

Methods: The authors identified 93 patients who underwent component release ventral hernia repair (2004 to 2012). The surgical technique involved release of the external oblique muscle lateral to the linea semilunaris. Using analytic morphomic techniques, the authors measured patients' morphology using routine preoperative computed tomography scans. Two-sample t test was used to evaluate the effect of morphomic and demographic factors on surgical-site infection. Separate logistic regression analyses were performed on these morphomic factors to evaluate their predictive value in assessing the risk of surgical site infection, controlling for demographic covariates.

Results: Surgical site infections were observed in 31 percent (n = 29) of the population. Subcutaneous fat area, total body area, and total body circumference had increased odds ratios for surgical site infection (p = 0.004, 0.014, and 0.012, respectively), indicating that these measures are better associated with surgical site infection than body mass index. These calculations control for demographic covariates, confirming that these morphomic parameters are predictive of surgical site infection.

Conclusion: Specific morphomic values serve as superior predictors of surgical site infection in patients undergoing component separation technique hernia repair than currently used values such as body mass index.

Clinical question/level of evidence: Risk, III.

MeSH terms

  • Abdominal Fat / diagnostic imaging*
  • Body Composition*
  • Comorbidity
  • Female
  • Hernia, Ventral / epidemiology*
  • Hernia, Ventral / surgery*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Preoperative Period
  • Risk Assessment
  • Surgical Mesh
  • Surgical Wound Infection / epidemiology*
  • Tomography, X-Ray Computed