What is the BMI threshold for open ventral hernia repair?

Area of Science:

• Surgical outcomes research
• Obesity and metabolic health
• Hernia surgery advancements

Background:

• Preoperative weight loss is often recommended for patients undergoing ventral hernia repair (VHR) to improve outcomes.
• Current guidelines lack specific body mass index (BMI) thresholds for predicting postoperative complications.
• Identifying BMI thresholds is crucial for effective patient counseling and risk stratification.

Purpose of the Study:

• To determine the body mass index (BMI) threshold associated with increased postoperative complications following ventral hernia repair (VHR).
• To provide data-driven recommendations for patient counseling regarding weight loss before VHR.

Main Methods:

• Retrospective analysis of open VHR patients (2002-2015) from the NSQIP database.
• Patients categorized into five BMI groups: <25, 25-29.99, 30-34.99, 35-39.99, and ≥40 kg/m².
• Multivariable logistic regression used to assess the association between BMI categories and postoperative complications.

Main Results:

• A total of 922 patients were analyzed, with 7.3% experiencing at least one postoperative complication.
• Patients with BMI ≥40 kg/m² had 2.89 times higher odds of complications compared to those with BMI <25 kg/m².
• No significant difference in complication rates was observed for BMI categories 25-29.99, 30-34.99, or 35-39.99 kg/m² compared to the lowest BMI group. Patients with BMI ≥40 kg/m² also had a higher rate of recurrent VHR (28.7% vs 14%).

Conclusions:

• Postoperative complications after VHR are significantly more likely in patients with a BMI of 40 kg/m² or higher.
• This high-BMI group also faces an increased risk of recurrent hernias, indicating a higher likelihood of adverse outcomes.
• Patients with BMI ≥40 kg/m² should be counseled to consider bariatric surgery before VHR; delaying VHR for weight loss in lower BMI groups may not offer advantages.