1,706 Cases of Abdominal Wall Reconstruction: What Factors Influence the Occurrence of Major Surgical Complications?

Introduction

Abdominal wall reconstruction (AWR) poses a significant surgical challenge and and these challenges are compounded in the setting of multiple failed attempts at repair and in high-risk patients.  We aim to assess risk factors for major surgical morbidity following AWR using the American College of Surgeons- National Surgery Quality Improvement Program (ACS-NSQIP) patient database.

Methods

A review of the ACS- NSQIP database of outcomes from 2005-2010 was performed to identify patients undergoing AWR utilizing CPT codes for ventral hernia repair and component separation.  Independent variables included patient demographics, medical co-morbidities and operative considerations.  Major surgical complication (deep wound infection, graft or prosthetic loss or unplanned return to the operating room within 30 days) was used as our dependent variable.  Stepwise-multivariate logistic regression was performed to evaluate patient risk factors influencing the occurrence of major surgical complications.

Results

1,706 patients with an average age of 55.9 years were identified with 30.1% undergoing concurrent intraabdominal procedures and 57.1% undergoing mesh repair.  Notable medical comorbidities included obesity (63.4%), smoking (24.9%), hypertension (53.1%), diabetes (19.9%) and anemia (22.6%).  Average operative time was 211.7 minutes.  Regression analysis determined that advanced age (p=0.005) was negatively associated, while ASA>2 (p=0.009) and prolonged operative time (p<0.001) were positively associated with the occurrence of major surgical complications.      

Conclusions

The results of our study identified a 13.4% rate of major surgical complications in our cohort of 1,706 patients.  We have found that operative time is a key prognostic factor when predicting the occurrence of major surgical complications for this complex and morbid surgical operation.