Incidence of Ventral Hernia Repair after Open Abdominal Aortic Aneurysm and Open Aortofemoral or Aortoiliac Bypass Surgery: An Analysis of 17,594 Patients in the State of New York

Abstract

The purpose of our study was to evaluate the rate of ventral hernia repair (VHR) after open abdominal aortic anneurysm in New York State compared with the rate of VHR after open abdominal aortic bypass procedures. The Statewide Planning and Research Cooperative System database was queried for all abdominal aortic aneurysm (AAA) and bypass procedures performed between 2000 and 2010. Social security death index was used to identify patients who died. The cause-specific Cox proportional hazard model was applied to compare the risk of having follow-up VHR between patients with AAA and bypass with death as a competing risk event. A multivariable model was used to explore independent relationship with the risk of having follow-up ventral hernia after adjusting for other factors. There were 9314 patients who underwent open AAA repair, 739 (7.93%) of which had subsequent VHR. Comparatively, 8280 patients underwent aortofemoral or aortoiliac bypass procedures, with 480 (5.8%) undergoing subsequent VHR. The observed one-year, five-year, and 10-year VHR rates for AAA versus bypass were 2.8 versus 1.8 per cent, 10.0 versus 8.0 per cent, 10.7 versus 9.38 per cent, respectively. After controlling for all other factors, patients undergoing AAA repair were more likely and elderly patients were less likely to undergo VHR (P < 0.0001). Patients with serious comorbid conditions such as valvular disease, diabetes mellitus, and neurologic disorders were less likely to undergo subsequent VHR controlling for other factors. VHR after AAA procedures is more common compared with bypass procedures for occlusive disease. Because this patient population has significant comorbidity, prophylactic mesh placement may play a role in preventing necessity for future procedures.

Abdominal Closure and the Risk of Incisional Hernia in Aneurysm Surgery – A Systematic Review and Meta-analysis

“…Hernias develop more rapidly (within the first 24 month) in patients with AAAs than they do in those patients with aorto-iliac occlusive disease. 10,42 Previous studies have shown that the cumulative hernia incidence increases continuously for up to seven years after the operation, 4,38,43 suggesting that AAA patients should perhaps be followed for longer.…”

Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery

“…In a study of 17,594 patients (9,314 with AAA and 8,280 with AOD) by Altieri et al,[ 19 ] after controlling for all other factors, patients undergoing AAA repair were more likely to undergo ventral hernia repair (7.93% with AAA and 5.8% with AOD). The authors concluded that prophylactic use of mesh might be considered in this patient population for future procedures due to their significant comorbidity.…”

Defining High-Risk Patients Suitable for Incisional Hernia Prevention

“…The high rate of association of IH after midline laparotomy in collagen disease patients related to abdominal aortic aneurism (AAA) has been widely demonstrated in studies of high scientific evidence (30)(31)(32). In this scenario, IH can reach up to 30%-60%.…”