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. 2023 Jul;37(7):5603-5611.
doi: 10.1007/s00464-022-09626-8. Epub 2022 Nov 7.

The impact of frailty on ventral hernia repair outcomes in a statewide database

Quintin P Solano  1   2 , Ryan Howard  2   3 , Cody L Mullens  2   3 , Anne P Ehlers  2   3 , Lia D Delaney  1   2 , Brian Fry  2   3 , Mary Shen  2   3 , Michael Englesbe  2   3   4 , Justin Dimick  2   3   4   5 , Dana Telem  6   7   8   9
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The impact of frailty on ventral hernia repair outcomes in a statewide database

Quintin P Solano et al. Surg Endosc. 2023 Jul.

Abstract

Introduction: Preoperative frailty is a strong predictor of postoperative morbidity in the general surgery population. Despite this, there are a paucity of research examining the effect of frailty on outcomes after ventral hernia repair (VHR), one of the most common abdominal operations in the USA. We examined the association of frailty with short-term postoperative outcomes while accounting for differences in preoperative, operative, and hernia characteristics.

Methods: We retrospectively reviewed the Michigan Surgery Quality Collaborative Hernia Registry (MSQC-HR) for adult patients who underwent VHR between January 2020 and January 2022. Patient frailty was assessed using the validated 5-factor modified frailty index (mFI5) and categorized as follows: no (mFI5 = 0), moderate (mFI5 = 1), and severe frailty (mFI5 ≥ 2). Our primary outcome was any 30-day complication. Multivariable logistic regression was used to evaluate the association of frailty with outcomes while controlling for patient, operative, and hernia variables.

Results: A total of 4406 patients underwent VHR with a mean age (SD) of 55 (15) years, 2015 (46%) females, and 3591 (82%) white patients. The mean (SD) BMI of the cohort was 33 (8) kg/m2. A total of 2077 (47%) patients had no frailty, 1604 (36%) were moderately frail, and 725 (17%) were severely frail. The median hernia size (interquartile range) was 2.5 cm (1.5-4.0 cm). Severe frailty was associated with increased odds of any complication (adjusted Odds Ratio (aOR) 3.12, 95% CI 1.78-5.47), serious complication (aOR 5.25, 95% CI 2.17-13.19), SSI (aOR 3.41, 95% CI 1.58-7.34), and post-discharge adverse events (aOR 1.70, 95% CI 1.24-2.33).

Conclusion: After controlling for patient, operative, and hernia characteristics, frailty was independently associated with increased odds of postoperative complications. These findings highlight the importance of preoperative frailty assessment for risk stratification and to inform patient counseling.

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Conflict of interest statement

Quintin Solano—No conflicts of interest, Ryan Howard MD MS—No conflicts of interest, Cody Mullens MD MPH—No conflicts of interest, Anne P Ehlers MD MPH—No conflicts of interest, Lia Delaney MS—No conflicts of interest, Brian Fry MD MS—No conflicts of interest, Mary Shen MD MS—No conflicts of interest, Michael Englesbe MD – No conflicts of interest, Justin Dimick MD MPH—No conflicts of interest, and Dana Telem MD MPH—Consulting fees from Medtronic.

Figures

Fig. 1
Fig. 1
Predicted probability of postoperative outcomes stratified by mFI5 score, Black = mFI5 = 0; Blue = mFI5 = 1; and Red = mFI5 = 2, *p-value < 0.05 compared to mFI5 = 0 (Color figure online)
Fig. 2
Fig. 2
Predicted probability of any postoperative complication over hernia size, Black = mFI5 = 0; Blue = mFI5 = 1; and Red = mFI5 = 2 (Color figure online)
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