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Advanced age does not affect abdominal wall reconstruction outcomes using acellular dermal matrix: A comparative

Salvatore Giordano1, Mark Schaverien1, Patrick B Garvey1

  • 1Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

American Journal of Surgery
|December 13, 2016
PubMed
Summary

Elderly patients (≥65 years) undergoing abdominal wall reconstruction (AWR) using acellular dermal matrix (ADM) do not experience worse outcomes. Age alone should not prevent older adults from receiving AWR.

Keywords:
Abdominal wallAcellular dermal matrixAdvanced ageElderlyHerniaOldPostoperative complicationsStratticeSurgiMendSurgical mesh

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Area of Science:

  • Surgical Innovation
  • Geriatric Surgery
  • Reconstructive Surgery

Background:

  • Complex abdominal wall reconstruction (AWR) is performed for hernias and oncologic resections.
  • The impact of advanced age on AWR outcomes using acellular dermal matrix (ADM) remains a critical consideration.

Purpose of the Study:

  • To investigate whether elderly patients (≥65 years) experience inferior outcomes after AWR compared to younger patients.
  • To evaluate hernia recurrence, surgical site occurrence (SSO), and bulging in elderly versus non-elderly AWR patients.

Main Methods:

  • A retrospective analysis of 511 patients undergoing complex AWR with ADM between 2005 and 2015.
  • Propensity score analysis was utilized for risk adjustment and one-to-one matching to compare elderly and non-elderly cohorts.
  • Primary outcome: hernia recurrence; Secondary outcomes: SSO and bulging.

Main Results:

  • Elderly patients (36%) showed similar hernia recurrence rates (7.6% vs 10.1%) and SSO rates (24.5% vs 23.5%) compared to non-elderly patients.
  • Bulging was significantly more frequent in the elderly group (6.5% vs 2.8%, p=0.04).
  • These findings persisted after propensity score adjustment.

Conclusions:

  • Contrary to the initial hypothesis, elderly patients undergoing AWR with ADM do not exhibit worse overall outcomes.
  • Age should not be a sole contraindication for AWR in elderly patients.
  • These results support the consideration of AWR for older adults with abdominal wall defects.