Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair

Surgery. 2019 Jul;166(1):94-101. doi: 10.1016/j.surg.2019.03.011. Epub 2019 May 13.

Abstract

Background: We aimed to assess the impact of modifiable comorbidities-obesity, diabetes, and smoking-and their aggregate effect on wound complications after incisional hernia repair.

Methods: Data on all open, elective, incisional hernia repair with permanent synthetic mesh in clean wounds were collected from the Americas Hernia Society Quality Collaborative and reviewed. Three groups were defined: those with 0, 1, or 2+ modifiable comorbidities, with associations described for each specific comorbid condition. Primary outcomes included surgical site occurrences, surgical site infections, and surgical site occurrences requiring procedural intervention.

Results: A total of 3,908 subjects met the inclusion criteria. Mean hernia width was 9.6 ± 6.5 cm, mean body mass index was 32.1 ± 6.6 kg/m2, 21% of patients had diabetes, and 9% were smokers. Of those, 31% had no modifiable comorbidities, 49% had 1 modifiable comorbidity, and 20% had 2+ modifiable comorbidities. Compared with having no modifiable comorbidities, having 1 modifiable comorbidity, or 2+ modifiable comorbidities significantly increased the odds of a surgical site occurrence (odds ratios 1.33 and 1.61, respectively). However, only patients with 2+ modifiable comorbidities had significantly increased odds of surgical site occurrences requiring procedural intervention compared with no modifiable comorbidities and 1 modifiable comorbidity (odds ratios 2.02 and 1.65, respectively). Patients with all 3 comorbidities had a two-fold increase in odds for all wound morbidity, followed similarly by obese patients with diabetes.

Conclusion: The presence of any number of comorbidities (1 modifiable comorbidity or 2+ modifiable comorbidities) increases the odds for wound events. However, having multiple comorbidities was associated with more procedural interventions for wound management. This was most evident in patients with all 3 comorbidities, and, in obese diabetics, underscoring the importance of preoperative counseling on expected recovery in such patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Comorbidity*
  • Databases, Factual
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / methods
  • Female
  • Herniorrhaphy / adverse effects*
  • Herniorrhaphy / methods
  • Humans
  • Incisional Hernia / surgery*
  • Laparotomy / adverse effects*
  • Laparotomy / methods
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Surgical Mesh / adverse effects
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / surgery*
  • Treatment Outcome
  • Wound Healing / physiology