Impact of panniculectomy in complex abdominal wall reconstruction: a propensity matched analysis in 624 patients
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and Other Interventional Techniques
2020 SAGES ORAL
Impact of panniculectomy in complex abdominal wall reconstruction: a propensity matched analysis in 624 patients Sharbel A. Elhage1 · Matthew N. Marturano1 · Eva B. Deerenberg1 · Jenny M. Shao1 · Tanushree Prasad1 · Paul D. Colavita1 · Kent W. Kercher1 · B. Todd Heniford1 · Vedra A. Augenstein1 Received: 5 April 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction In complex abdominal wall reconstruction (AWR), the role of concomitant panniculectomy has been debated due to concern for increased wound complications that impact outcomes; however, long-term outcomes and quality of life (QOL) have not been well described. The aim of our study was to evaluate the outcomes and QOL in patients undergoing AWR with panniculectomy utilizing 3D volumetric-based propensity match. Methods A prospective database from a tertiary referral hernia center was queried for patients undergoing open AWR. 3D CT volumetrics were analyzed and a propensity match comparing AWR patients with and without panniculectomy was created including subcutaneous fat volume (SFV). QOL was analyzed using the Carolinas Comfort Scale. Results Propensity match yielded 312 pairs, all with adequate CT imaging for volumetric analysis. The panniculectomy group had a higher BMI (p = 0.03) and were more likely female (p 0.05). Overall wound occurrences were higher in the panniculectomy group at 44.5% versus 32.3% (p = 0.002); however, when individual wound complications were assessed (Table 3), the break point for the difference was that the panniculectomy group had a higher rate of superficial wound breakdown (p = 0.003) only. Hernia recurrence was similar between the groups with over two years (28 months) of follow-up (p > 0.05). Quality of life data were obtained at 2 weeks, 1 month, 6 months, and 12 months. Data were available on an average of 139 patients for each time period. At 2 weeks, 1 month, and 6 months, mesh sensation, pain, activity limitation, Table 1 Patients characteristics
Age (years) Female BMI (kg/m2) Comorbidity Cirrhosis Congestive heart failure COPD Coronary artery disease Current steroid use Diabetes mellitus History of smoking Obstructive sleep apnea Peripheral vascular disease ASA score I II III IV
No panniculectomy (n = 312)
Panniculectomy (n = 312)
p-value
58.9 ± 12.2 52.6% 34.7 ± 7.4
58.6 ± 11.7 71.2% 35.7 ± 7.1
0.96 0.99 0.65 0.65 0.17
LOS length of stay, AKI acute kidney injury, DVT deep venous thrombus, PE pulmonary embolism, MI myocardial infarction
and overall quality of life were all similar between the two groups (all p > 0.05). At 12 months, mesh sensation, pain, and overall quality of life remain similar (all p > 0.05); however, activity limitation was bothersome in a higher number
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of panniculectomy patients (p = 0.04). QOL outcomes are shown in Fig. 1.
Discussion This study of 624 patients, who constituted 312 one-to-one propensity matched pairs undergoing complex,
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