Development of a Clinically Actionable Incisional Hernia Risk Model after Colectomy Using the Healthcare Cost and Utilization Project

Weissler, Jason M.; Lanni, Michael A.; Hsu, Jesse Y.; Tecce, Michael G.; Carney, Martin J.; Kelz, Rachel R.; Fox, Justin P.; Fischer, John P.

doi:10.1016/j.jamcollsurg.2017.04.007

Cited by 21 publications

(22 citation statements)

References 47 publications

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“…The findings from this study are supported by prior reports in which overweight and obesity demonstrated an observed association with surgical site infections [10][11][12][13][14][15][16][17][18][19][20][21][22][23] and incisional hernias. [17,53,54] While these clinical associations have been demonstrated previously, the use of Mendelian randomization in this study suggests a possible causal role for obesity in the development of postoperative infections and incisional hernias.…”

Section: Discussionsupporting

confidence: 64%

Association of Genetic Risk of Obesity with Postoperative Complications Using Mendelian Randomization

et al. 2019

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Background:The extent to which obesity and genetics determine post-operative complications is incompletely understood. Methods:We performed a retrospective study using two population cohorts with electronic health record (EHR) data. The first included 736,726 adults with body mass index (BMI) recorded between 1990-2017 at Vanderbilt University Medical Center. The second cohort consisted of 65,174 individuals from 12 institutions contributing EHR and genome-wide genotyping data to the Electronic Medical Records & Genomics (eMERGE) Network. Pairwise logistic regression analyses were used to measure the association of BMI categories with postoperative complications derived from International Classification of Disease-9 codes, including postoperative infection, incisional hernia, and intestinal obstruction. A genetic risk score (GRS) was constructed from 97 obesity-risk single nucleotide polymorphisms for a Mendelian randomization study to determine the association of genetic risk for obesity on postoperative complications. Logistic regression analyses were adjusted for sex, age, site, and race/principal components.Results: Individuals with overweight or obese BMI (≥25 kg/m 2 ) had increased risk for incisional hernia (Odds ratio [OR] 1.7-5.5, p<3.1×10 −20 ), and people with obesity (BMI≥30 kg/m 2 ) had increased risk for postoperative infection (OR 1.2-2.3, p<2.5×10 −5 ). In the eMERGE cohort, genetically-predicted BMI was associated with incisional hernia (OR 2.1 [95% CI 1.8-2.5], p=1.4×10 −6 ) and postoperative infection (OR 1.6 [95% CI 1.4-1.9], p=3.1×10 −6 ). Association findings were similar after limitation of the cohorts to those who underwent abdominal procedures.Conclusions: Clinical and Mendelian randomization studies suggest that obesity, as measured by BMI, is associated with the development of postoperative incisional hernia and infection.

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Section: Discussionsupporting

confidence: 64%

Association of Genetic Risk of Obesity with Postoperative Complications Using Mendelian Randomization

et al. 2019

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“…40 A few percent reduction of incisional hernia may indeed be clinically relevant, given the burden to the patient and costs related to incisional hernia repair. 41,42 The findings of this study should be interpreted in light of some shortcomings. First, PSM may decrease the influence of selection bias but does not correct for unmeasured covariates.…”

Section: Discussionmentioning

confidence: 86%

International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy

Poel

Fichtinger

Görgec

et al. 2021

HPB

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Background: Despite a lack of high-level evidence, current guidelines recommend laparoscopic left lateral sectionectomy (LLLS) as the routine approach over open LLS (OLLS). Randomized studies and propensity score matched studies on LLLS vs OLLS for all indications, including malignancy, are lacking.Methods: This international multicenter propensity score matched retrospective cohort study included consecutive patients undergoing LLLS or OLLS in six centers from three European countries (January 2000-December 2016). Propensity scores were calculated based on nine preoperative variables and LLLS and OLLS were matched in a 1:1 ratio. Short-term operative outcomes were compared using paired tests.Results: A total of 560 patients were included. Out of 200 LLLS, 139 could be matched to 139 OLLS.After matching, baseline characteristics were well balanced. LLLS was associated with shorter operative time (144 (110-200) vs 199 (138-283) minutes, P < 0.001), less blood loss (100 (50-300) vs 350 (100-750) mL, P = 0.005) and a 3-day shorter postoperative hospital stay (4 (3-7) vs 7 (5-9) days, P < 0.001). Conclusion:This international multicenter propensity score matched study confirms the superiority of LLLS over OLLS based on shorter postoperative hospital stay, operative time, and less blood loss thus validating current guideline advice.

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“…independent of other risk factors and confounders. 6,8,13 Nagaraju et al revealed that obesity is a common predisposing factor. Obese female has an increased predilection toward incisional hernia.…”

Section: Resultsmentioning

confidence: 99%

Study prevalence of risk factors and clinical presentation of ventral incisional hernia an observational study

2020

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Background: Incisional hernia is the second most common type of hernia after inguinal hernia. It is a complication of abdominal surgery, reported in up to 11% of patients generally and in up to 20% of those who developed post operative wound infection. The list of predictive factors associated with development of incisional hernia is obesity, diabetes mellitus, steroid, smoking, old age, malnutrition, COPD and type of incision.Methods: This was a hospital based cross sectional observational study carried out from February 2018 - October 2019 in surgery department of Dr. B.R.A.M. Hospital Raipur C.G, with diagnosis of incisional hernia. Total 100 patients were included in the study.Results: In present study the mean age of study subjects was 47.27±13.16 years. Around two-third 64% were females. 40% of perforation and 35% of LSCS cases later develop to Incisional hernia. Risk factors profile showed that 31% were alcoholic, 27% smokers, 48% pre-obese and 5% were obese. 36% were hypertensive, 48% diabetic, and 12% had constipation. 25% had prolonged cough, 35% had surgical site infection, 45% had anemia. Clinical presentation of study subjects showed that 63% had swelling, 33% had swelling and pain and 4% had obstruction.Conclusions: Incisional hernia is more common in female than males and in cases above the age of 45 years. It is more common in patients who underwent the previous surgery on an emergency basis especially in perforation and obstruction and LSCS cases. Risk factors associated with incisional hernia are smoker, alcoholic, obesity, hypertension, diabetes, constipation, prolong cough and anemia.

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Development of a Clinically Actionable Incisional Hernia Risk Model after Colectomy Using the Healthcare Cost and Utilization Project

Cited by 21 publications

References 47 publications

Association of Genetic Risk of Obesity with Postoperative Complications Using Mendelian Randomization

Association of Genetic Risk of Obesity with Postoperative Complications Using Mendelian Randomization

International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy

Study prevalence of risk factors and clinical presentation of ventral incisional hernia an observational study

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