Preoperative Anemia is a Risk Factor for Poor Perioperative Outcomes in Ventral Hernia Repair

Overview

Journal Hernia

Publisher Springer

Date 2022 Feb 17

PMID 35175459

Authors

C Benner

K T Spence

W K Childers

Affiliations

Soon will be listed here.

Abstract

Purpose: Ventral hernia repairs (VHR) are among the most commonly performed operations by general surgeons. Despite advances in technology there remains high complication and readmission rates. Preoperative anemia has been linked to poor outcomes and readmission across several surgical procedures, however the link to ventral hernia repair outcomes is limited.

Methods: Utilizing the American College of Surgeons National Safety and Quality Improvement Project (NSQIP) database for years 2016-2018, a total of 115,000 patients met inclusion criteria. Using propensity matching we matched two groups of patients who underwent VHR: (1) those with preoperative anemia and (2) those with normal hemoglobin levels. Anemia criteria was set forth by the World Health Organization (WHO).

Results: Univariate analysis did demonstrate statistical significance in post-operative outcomes percentage of serious surgical site infection, poor renal outcomes, transfusion, and unplanned remission in those with preoperative anemia who underwent VHR. In a multivariate analysis, patients who underwent ventral hernia repair with pre-operative anemia had significantly greater odds of unplanned readmission (odds ratio 1.35, 95% confidence interval 1.16-1.57) and serious surgical site infection (odds ratio 1.35, 95% confidence interval 1.04-1.74) independent of known risk factors such as smoking, diabetes and obesity.

Conclusions: Preoperative anemia is a risk factor for poor postoperative outcomes in those undergoing ventral hernia repair and should be considered when evaluating a patient for repair.

References

Blatnik J, Harth K, Aeder M, Rosen M . Thirty-day readmission after ventral hernia repair: predictable or preventable?. Surg Endosc. 2010; 25(5):1446-51. DOI: 10.1007/s00464-010-1412-4. View

Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T . Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg. 2013; 37(10):2273-9. DOI: 10.1007/s00268-013-2123-5. View

Pearson D, Carbonell A . Obesity and Abdominal Wall Reconstruction: Outcomes, Implications, and Optimization. Plast Reconstr Surg. 2018; 142(3 Suppl):30S-35S. DOI: 10.1097/PRS.0000000000004845. View

Novitsky Y, Orenstein S . Effect of patient and hospital characteristics on outcomes of elective ventral hernia repair in the United States. Hernia. 2013; 17(5):639-45. DOI: 10.1007/s10029-013-1088-5. View

Park H, de Virgilio C, Kim D, Shover A, Moazzez A . Effects of smoking and different BMI cutoff points on surgical site infection after elective open ventral hernia repair. Hernia. 2020; 25(2):337-343. DOI: 10.1007/s10029-020-02190-x. View

Weissler J, Lanni M, Hsu J, Tecce M, Carney M, Kelz R . Development of a Clinically Actionable Incisional Hernia Risk Model after Colectomy Using the Healthcare Cost and Utilization Project. J Am Coll Surg. 2017; 225(2):274-284.e1. DOI: 10.1016/j.jamcollsurg.2017.04.007. View

Nguyen M, Li L, Hicks S, Davila J, Suliburk J, Leong M . Readmission following open ventral hernia repair: incidence, indications, and predictors. Am J Surg. 2013; 206(6):942-8. DOI: 10.1016/j.amjsurg.2013.08.022. View

Lovecchio F, Farmer R, Souza J, Khavanin N, Dumanian G, Kim J . Risk factors for 30-day readmission in patients undergoing ventral hernia repair. Surgery. 2014; 155(4):702-10. DOI: 10.1016/j.surg.2013.12.021. View

Poulose B, Shelton J, Phillips S, Moore D, Nealon W, Penson D . Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2011; 16(2):179-83. DOI: 10.1007/s10029-011-0879-9. View

10.

Cox T, Blair L, Huntington C, Colavita P, Prasad T, Lincourt A . The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res. 2016; 206(1):214-222. DOI: 10.1016/j.jss.2016.08.009. View

11.

Leeds I, Canner J, Gani F, Meyers P, Haut E, Efron J . Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes. Ann Surg. 2018; 271(1):114-121. PMC: 8559326. DOI: 10.1097/SLA.0000000000002851. View

12.

Saleh S, Plymale M, Davenport D, Roth J . Risk-Assessment Score and Patient Optimization as Cost Predictors for Ventral Hernia Repair. J Am Coll Surg. 2018; 226(4):540-546. DOI: 10.1016/j.jamcollsurg.2017.12.022. View

13.

Saager L, Turan A, Reynolds L, Dalton J, Mascha E, Kurz A . The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients. Anesth Analg. 2013; 117(4):909-915. DOI: 10.1213/ANE.0b013e31828b347d. View

14.

Wu W, Schifftner T, Henderson W, Eaton C, Poses R, Uttley G . Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA. 2007; 297(22):2481-8. DOI: 10.1001/jama.297.22.2481. View

15.

Musallam K, Tamim H, Richards T, Spahn D, Rosendaal F, Habbal A . Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011; 378(9800):1396-407. DOI: 10.1016/S0140-6736(11)61381-0. View

16.

Fowler A, Ahmad T, Phull M, Allard S, Gillies M, Pearse R . Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015; 102(11):1314-24. DOI: 10.1002/bjs.9861. View

17.

Baron D, Hochrieser H, Posch M, Metnitz B, Rhodes A, Moreno R . Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth. 2014; 113(3):416-23. DOI: 10.1093/bja/aeu098. View

18.

Liu L, Liu L, Liang L, Zhu Z, Wan X, Dai H . Impact of Preoperative Anemia on Perioperative Outcomes in Patients Undergoing Elective Colorectal Surgery. Gastroenterol Res Pract. 2018; 2018:2417028. PMC: 5964567. DOI: 10.1155/2018/2417028. View

19.

Leichtle S, Mouawad N, Lampman R, Singal B, Cleary R . Does preoperative anemia adversely affect colon and rectal surgery outcomes?. J Am Coll Surg. 2011; 212(2):187-94. DOI: 10.1016/j.jamcollsurg.2010.09.013. View

20.

Sarhane K, Flores J, Cooney C, Abreu F, Lacayo M, Baltodano P . Preoperative Anemia and Postoperative Outcomes in Immediate Breast Reconstructive Surgery: A Critical Analysis of 10,958 Patients from the ACS-NSQIP Database. Plast Reconstr Surg Glob Open. 2014; 1(5):e30. PMC: 4174195. DOI: 10.1097/GOX.0b013e3182a18c6f. View