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Area of Science:

  • Surgical outcomes research
  • Obesity and bariatric surgery
  • Patient prehabilitation strategies

Background:

  • Obesity and poor physical condition increase ventral hernia repair (VHR) complication risks.
  • These health disparities disproportionately affect low socioeconomic status populations.
  • Prehabilitation aims to mitigate these risks through targeted interventions.

Purpose of the Study:

  • To evaluate the efficacy of prehabilitation (nutritional counseling and exercise) in obese patients undergoing VHR.
  • To determine if prehabilitation increases the proportion of patients who are hernia-free and complication-free post-VHR.
  • To assess secondary outcomes including wound complications and weight loss.

Main Methods:

  • A blinded, randomized controlled trial was conducted at a safety-net academic institution.
  • Obese patients (BMI 30-40) were randomized to prehabilitation or standard care.
  • VHR was performed after meeting preoperative criteria (7% weight loss or 6 months of counseling).

Main Results:

  • Prehabilitation led to greater weight loss and goal achievement but also higher dropout rates.
  • The prehabilitation group showed a trend toward fewer wound complications (6.8% vs. 17.6%).
  • Significantly more prehabilitation patients were hernia-free and complication-free (69.5% vs. 47.5%, P=0.015).

Conclusions:

  • Implementing prehabilitation programs for obese patients in safety-net hospitals is feasible.
  • Prehabilitation enhances the likelihood of successful VHR outcomes, with patients being hernia-free and complication-free.
  • While beneficial, prehabilitation may increase risks of patient dropout and emergent surgical repair, necessitating further investigation.