Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique

Abstract

Background The component separation technique (CST) is considered an excellent technique for complex ventral hernia repair. However, postoperative infectious complications and reherniation rates are significant. Risk factor analysis for postoperative complication and reherniation has focused mostly on patient history and co-morbidity and shows equivocal results. The use of abdominal morphometrics derived from CT scans to assist in risk assessment seems promising. The aim of this study is to determine the predictability of reherniation and surgical site infections (SSI) using pre-operative CT measurements. Methods Electronic patient records were searched for patients who underwent CST between 2000 and 2013 and had a pre-operative CT scan available. Visceral fat volume (VFV), subcutaneous fat volume (SFV), loss of domain (LOD), rectus thickness and width (RT, RW), abdominal volume, hernia sac volume, total fat volume (TFV), sagittal distance (SD) and waist circumference (WC) were measured or calculated. Relevant variables were entered in multivariate regression analysis to determine their effect on reherniation and SSI as separate outcomes. Results Sixty-five patients were included. VFV ( p = 0.025, OR = 1.65) was a significant predictor regarding reherniation. Hernia sac volume ( p = 0.020, OR = 2.10) and SFV per 1000 cm 3 ( p = 0.034, OR = 0.26) were significant predictors of SSI. Conclusion Visceral fat volume, subcutaneous fat volume and hernia sac volume derived from CT scan measurements may be used to predict reherniation and SSI in patients undergoing complex ventral hernia repair using CST. These findings may aid in optimizing patient-tailored preoperative risk assessment.

Computed Tomography Image Analysis in Abdominal Wall Reconstruction: A Systematic Review

“… 11 , 14 – 20 The remaining 4 studies were of “poor” quality due to no comparative analysis built into the study design. 6 , 21 – 23 No study had a total score < 4.…”

“… 17 In patients undergoing component separation, visceral fat volume was a significant predictor of recurrence. 6 Subcutaneous fat, specifically, has been demonstrated as an independent risk factor for SSI. 6 , 26 In fact, subcutaneous fat was a better predictors of SSI compared with BMI.…”

“…Current risk factor analysis of postoperative complications is limited and focus on patient history and co-morbidity. 6 As standard of care, surgeons rely on physical examination and radiologic imaging; however computed tomography (CT) features are not extensively studied to predict surgical outcomes. 7 , 8 Despite their lack of incorporation into surgical practices, CT scans are readily ordered as part of the routine work up of preoperative planning.…”

The Value of Morphometric Measurements in Risk Assessment for Donor-Site Complications after Microsurgical Breast Reconstruction

“…Moreover, the use of preoperative CTA-derived measurements also appears promising in the field of vascular surgery, in which a specific measurement, namely, core muscle size, correlates with postoperative mortality [ 61 ]. Nonetheless, morphological measurements of fat tissue seem to have a high impact on risk assessment for postoperative donor-site complications in general surgery [ 16 , 17 , 62 ] and in abdominally-based breast reconstruction [ 13 ].…”

Psoas CT Attenuation and Fatty Infiltration Rate Predict Incisional Hernia After Appendicectomy

“…Furthermore, fat and fat-free tissue measurement at L3 level using CT strongly correlate with whole-body fat and fat-free mass [16]. Numerous studies have delineated that visceral fat area and subcutaneous fat area measured on CT image can predict re-herniation and surgical site infection [17,18]. Moreover, visceral obesity, rather than elevated BMI, is associated with IH after colorectal surgery [19,20].…”