Building a Center for Abdominal Core Health: The Importance of a Holistic Multidisciplinary Approach

Seaman, Austin P; Schlosser, Kathryn A.; Eiferman, Daniel; Narula, Vimal K.; Poulose, Benjamin K.; Janis, Jeffrey E.

doi:10.1007/s11605-021-05241-5

Cited by 5 publications

(3 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ventral hernias can lead to significant financial burden and poor quality of life, thus the establishment of tertiary, regional referral centers has been particularly beneficial for patients with complex and burdensome defects [ 18 , 19 ]. The multidisciplinary approach at such Centers of Excellence has contributed to improved patient outcomes, but what remains unclear is how equitable access to these centers really is [ 20 , 21 ]. Although Shulkin et al suggested that hernia centers are evenly distributed across the country, this initial investigation of our own hernia center suggests there remain disparities in availability to high-risk populations [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Holland,

Mead,

Lorenz

et al. 2024

J. Abdom. Wall Surg.

View full text Add to dashboard Cite

Background: Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but less so in elective abdominal wall reconstruction (AWR). The goal of this study was to evaluate the disparities in referrals to a tertiary hernia center.Methods: A prospectively maintained hernia database was queried for patients who underwent open ventral hernia (OVHR) or minimally invasive surgical (MISR) repair from 2011 to 2022 with complete insurance and address information. Patients were divided by home address into in-state (IS) and out-of-state (OOS) referrals as well as by operative technique. Demographic data and outcomes were compared. Standard and inferential statistical analyses were performed.Results: Of 554 patients, most were IS (59.0%); 334 underwent OVHR, and 220 underwent MISR. IS patients were more likely to undergo MISR (OVHR: 45.6% vs. 81.5%, laparoscopic: 38.2% vs. 14.1%, robotic: 16.2% vs. 4.4%; p < 0.001) when compared to OOS referrals. Of OVHR patients, 44.6% were IS and 55.4% were OOS. Patients’ average age and BMI, sex, ASA score, and insurance payer were similar between IS and OOS groups. IS patients were more often Black (White: 77.9% vs. 93.5%, Black: 16.8% vs. 4.3%; p < 0.001). IS patients had more smokers (12.1% vs. 3.2%; p = 0.001), fewer recurrent hernias (45.0% vs. 69.7%; p < 0.001), and smaller defects (155.7 ± 142.2 vs. 256.4 ± 202.9 cm2; p < 0.001). Wound class, mesh type, and rate of fascial closure were similar, but IS patients underwent fewer panniculectomies (13.4% vs. 34.1%; p < 0.001), component separations (26.2% vs. 51.4%; p < 0.001), received smaller mesh (744.2 ± 495.6 vs. 975.7 ± 442.3 cm2; p < 0.001), and had shorter length-of-stay (4.8 ± 2.0 vs. 7.0 ± 5.5 days; p < 0.001). There was no difference in wound breakdown, seroma requiring intervention, hematoma, mesh infection, or recurrence; however, IS patients had decreased wound infections (2.0% vs. 8.6%; p = 0.009), overall wound complications (11.4% vs. 21.1%; p = 0.016), readmissions (2.7% vs. 13.0%; p = 0.001), and reoperations (3.4% vs. 11.4%; p = 0.007). Of MISR patients, 80.9% were IS and 19.1% were OOS. In contrast to OVHR, MISR IS and OOS patients had similar demographics, preoperative characteristics, intraoperative details, and postoperative outcomes.Conclusion: Although there were no differences in referred patients for MISR, this study demonstrates the racial disparities that exist among our IS and OOS complex, open AWR patients. Awareness of these disparities can help clinicians work towards equitable access to care and equal referrals to tertiary hernia centers.

show abstract

Section: Discussionmentioning

confidence: 99%

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Holland,

Mead,

Lorenz

et al. 2024

J. Abdom. Wall Surg.

View full text Add to dashboard Cite

show abstract

“…In addition, the prognostic nutritional index (PNI) has emerged as a valuable tool for assessing nutritional status and predicting perioperative outcomes in patients undergoing orthopaedic surgery. 9 , 10 A lower PNI is often correlated with adverse outcomes, including poor wound healing, highlighting the need for targeted nutritional interventions in these patients.…”

Section: Introductionmentioning

confidence: 99%

The impact of early nutritional support on postoperative wound healing in patients with complex fractures: A meta‐analysis review

Bao,

Chu,

Zhang

et al. 2024

International Wound Journal

View full text Add to dashboard Cite

Complex fractures present significant challenges in orthopaedic surgery, particularly in terms of postoperative wound healing. Nutritional status plays a crucial role in the recovery process, with early nutritional support potentially influencing wound healing outcomes. This meta‐analysis aimed to assess the impact of early nutritional interventions on postoperative wound healing and scar formation in patients with complex fractures. From an initial pool of 1742 articles, 7 studies were selected for analysis. The results revealed that preoperative nutritional support significantly improved early wound healing, as indicated by lower REEDA scores (SMD = −14.06, 95% CI: [−16.79, −11.32], p < 0.01) 1 week post‐surgery. Furthermore, there was a notable reduction in scar formation, as demonstrated by lower Manchester Scar Scale scores (SMD = −25.03, 95% CI: [−30.32, −19.74], p < 0.01) 3 months post‐surgery. These findings highlight the importance of incorporating nutritional strategies into the management of complex fractures to optimize postoperative recovery.

show abstract

“…These defects often require complex techniques including component separation, tissue rearrangement, mesh implantation, and often a combination of multiple techniques. Surgical management of complex abdominal hernias is often managed by a multidisciplinary team, 1,2 particularly because these patients often have undergone multiple previous repairs or have significant comorbidities that puts them at increased risk for postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Perioperative Fluid Management in Complex Abdominal Wall Reconstruction to Prevent Postoperative Acute Kidney Injury

Shelby

Eiferman

Janis

2022

The American Surgeon™

Self Cite

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) is a serious postoperative complication of abdominal wall reconstruction that can significantly impact outcomes of these patients. This study examines AKI following abdominal wall hernia repair to determine incidence and risk factors and outline potential mitigation strategies. Methods Using a single institution IRB-approved prospective database, patients undergoing complex abdominal wall reconstruction from 2013 to 2021 were identified. Patients with AKI were compared to controls and preoperative and intraoperative characteristics were evaluated. Multivariate analysis was utilized to identify factors associated with development of AKI. Results 297 patients were reviewed, 21.2 % (n = 63 patients) had AKI. Patients with AKI had a greater decrease in postoperative GFR to preoperative GFR (40.5% vs 18.3%, p <0.0001). Factors associated with AKI included ASA score >2 (odds ratio (OR) = 2.10, [1.50; 5.12], p = 0.02), HTN (OR = 2.05, [1.05; 4.0], p = 0.04), higher baseline Cr (OR = 5.98, [2.56; 13.98], p <0.0001), and diabetes (OR = 0.135, [0.0275; 0.666], p = 0.01). Operative time was longer in patients who developed AKI [average 400 min (range: 278-510 min) vs 310 min (range: 260-374 min), p = 0.04] and was an independent predictor of developing AKI (OR = 319.59, [137.25; 744.65], p <0.0001). Discussion Preoperative identification of patients with medical comorbidities undergoing elective complex abdominal wall reconstruction continues to be imperative to improve outcomes. This study demonstrates that perioperative management for high risk patients requires flexibility, including potential adjustments to enhanced recovery after surgery protocols in order to adequately address the risks for AKI.

show abstract

Building a Center for Abdominal Core Health: The Importance of a Holistic Multidisciplinary Approach

Cited by 5 publications

References 98 publications

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

The impact of early nutritional support on postoperative wound healing in patients with complex fractures: A meta‐analysis review

Optimizing Perioperative Fluid Management in Complex Abdominal Wall Reconstruction to Prevent Postoperative Acute Kidney Injury

Contact Info

Product

Resources

About