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Is There an Association between Component Separation and Venous Thromboembolism? Analysis of the NSQIP.

Kim K, Mella JR, Ibrahim AM, Koolen PG, Lin SJ - Plast Reconstr Surg Glob Open (2015)

Bottom Line: However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively).Several risk factors were significantly associated with postoperative complications in both groups.Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and Department of Surgery, Boston Medical Center, Boston, Mass.

ABSTRACT

Background: Patients undergoing incisional/ventral hernia repair are at risk of developing several postoperative complications particularly venous thromboembolism (VTE), which is a major cause of morbidity and mortality. The aim of this study was to assess 30-day postoperative morbidity and mortality of patients undergoing incisional/ventral hernia repair and to determine the association between component separation and VTE.

Methods: We reviewed the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program databases to identify patients undergoing incisional/ventral hernia repair. Preoperative variables and postoperative outcomes were compared between a component separation group and a non-component separation group. The χ(2) tests and Fisher's exact test were used for categorical variables and t tests for continuous variables. Logistic regression analysis was performed to determine preoperative predictors for complications in both groups.

Results: Thirty-four thousand five hundred forty-one patients were included in our study; 501 patients underwent a component separation procedure. A higher rate of wound complications, minor/major morbidity, mortality, and return to the operating room occurred in the component separation group. However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively). Several risk factors were significantly associated with postoperative complications in both groups.

Conclusions: Component separation is used for large and complex incisional/ventral hernia repairs to achieve tension-free midline closure. Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.

No MeSH data available.


Related in: MedlinePlus

Patient selection process.
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Figure 1: Patient selection process.

Mentions: We performed a retrospective analysis of patients who underwent incisional/ventral hernia repair using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases for the years 2005–2011. The ACS-NSQIP is a well-validated, observational cohort study of patients undergoing non-cardiac procedures under general, spinal, or epidural anesthesia in more than 400 medical centers nationwide. ACS-NSQIP tracks patients for 30 days after their operation, providing a more comprehensive picture of their care.18 Patients were identified using Current Procedural Terminology (CPT) codes for incisional/ventral hernia repair (CPT codes: 49560, 49561, 49565, and 49566). Patients who underwent a concurrent intra-abdominal procedure or one involving another part of the body were excluded to eliminate their confounding effect on outcome. However, panniculectomy (often performed as a concurrent procedure because of the optimized elevation of abdominal pannus), skin closure procedure (frequently coded as a separate procedure but done when repairing large abdominal wound defects), and mesh implantation (may be included in the ventral hernia repair and therefore was incorporated in our analysis) were not used as exclusion criteria. We divided our patient population into 2 groups. The first group consisted of patients who underwent incisional/ventral hernia repair without the use of component separation; the second group consisted of patients with ventral hernias who were managed with component separation. The CPT code 15734 (muscle, myocutaneous, or fasciocutaneous flap) was used to identify component separation procedure in which the aponeurosis of the external oblique muscle is longitudinally incised, and the rectus muscle is mobilized toward the midline to facilitate abdominal fascia closure19 (Fig. 1).


Is There an Association between Component Separation and Venous Thromboembolism? Analysis of the NSQIP.

Kim K, Mella JR, Ibrahim AM, Koolen PG, Lin SJ - Plast Reconstr Surg Glob Open (2015)

Patient selection process.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494499&req=5

Figure 1: Patient selection process.
Mentions: We performed a retrospective analysis of patients who underwent incisional/ventral hernia repair using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases for the years 2005–2011. The ACS-NSQIP is a well-validated, observational cohort study of patients undergoing non-cardiac procedures under general, spinal, or epidural anesthesia in more than 400 medical centers nationwide. ACS-NSQIP tracks patients for 30 days after their operation, providing a more comprehensive picture of their care.18 Patients were identified using Current Procedural Terminology (CPT) codes for incisional/ventral hernia repair (CPT codes: 49560, 49561, 49565, and 49566). Patients who underwent a concurrent intra-abdominal procedure or one involving another part of the body were excluded to eliminate their confounding effect on outcome. However, panniculectomy (often performed as a concurrent procedure because of the optimized elevation of abdominal pannus), skin closure procedure (frequently coded as a separate procedure but done when repairing large abdominal wound defects), and mesh implantation (may be included in the ventral hernia repair and therefore was incorporated in our analysis) were not used as exclusion criteria. We divided our patient population into 2 groups. The first group consisted of patients who underwent incisional/ventral hernia repair without the use of component separation; the second group consisted of patients with ventral hernias who were managed with component separation. The CPT code 15734 (muscle, myocutaneous, or fasciocutaneous flap) was used to identify component separation procedure in which the aponeurosis of the external oblique muscle is longitudinally incised, and the rectus muscle is mobilized toward the midline to facilitate abdominal fascia closure19 (Fig. 1).

Bottom Line: However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively).Several risk factors were significantly associated with postoperative complications in both groups.Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and Department of Surgery, Boston Medical Center, Boston, Mass.

ABSTRACT

Background: Patients undergoing incisional/ventral hernia repair are at risk of developing several postoperative complications particularly venous thromboembolism (VTE), which is a major cause of morbidity and mortality. The aim of this study was to assess 30-day postoperative morbidity and mortality of patients undergoing incisional/ventral hernia repair and to determine the association between component separation and VTE.

Methods: We reviewed the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program databases to identify patients undergoing incisional/ventral hernia repair. Preoperative variables and postoperative outcomes were compared between a component separation group and a non-component separation group. The χ(2) tests and Fisher's exact test were used for categorical variables and t tests for continuous variables. Logistic regression analysis was performed to determine preoperative predictors for complications in both groups.

Results: Thirty-four thousand five hundred forty-one patients were included in our study; 501 patients underwent a component separation procedure. A higher rate of wound complications, minor/major morbidity, mortality, and return to the operating room occurred in the component separation group. However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively). Several risk factors were significantly associated with postoperative complications in both groups.

Conclusions: Component separation is used for large and complex incisional/ventral hernia repairs to achieve tension-free midline closure. Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.

No MeSH data available.


Related in: MedlinePlus