Robotic retromuscular hernia repair optimizes short-term outcomes in higher risk patients

Smoking, obesity, diabetes mellitus, and COPD are known risk factors for surgical site occurrences (SSO) following open ventral hernia repair. However, little evidence exists on whether these factors also significantly impact SSO after robotic hernia repair. This is a particularly important distinction because robotic approaches have been associated with fewer wound complications. Our aim was to examine the impact of smoking, obesity, diabetes mellitus, and COPD on postoperative SSO after robotic retromuscular hernia repair.

A retrospective review was conducted of a prospectively maintained database of ventral hernia repairs at three hospitals within our system from October 2019 to July 2022. These included extended totally extraperitoneal (eTEP) and transabdominal approaches along with transversus abdominis release (TAR). Patient demographics, preoperative evaluation, operative details, 30-day follow-up, and patient-reported outcomes were recorded in the Abdominal Core Health Quality Collaborative (ACHQC) database. Patients were grouped according to exposure; smokers vs. non-smokers, obesity (BMI > 40 vs. < 40), and the presence or absence of diabetes mellitus or COPD. The main outcome measure was SSO at one month follow-up. Logistic regression models were used to determine the association between smoking, obesity, diabetes mellitus, and COPD with postoperative SSO.

A total of 81 adult patients were included; mean age was 55 ± 13 years and 41% were women. ASA scores were as follows: 1 (0%), 2 (30%), 3 (64%), and 4 (4%). The prevalence of risk factors were smoking 17%, obesity 16%, diabetes mellitus 28%, and COPD 6%. The overall SSO rate at 30-day follow-up was 12.2%. SSO rates for obese vs. non-obese patients were 15.4% vs. 11.5%, respectively (p = 0.7). For smokers, the rate of SSO compared to non-smokers was 11.1% vs. 13.3% (p = 0.5). Logistic regression models showed that obesity (OR 0.75, 95% CI 0.13, 4.31; p = 0.7), diabetes (OR 2.04, 95% CI 0.36, 11.7; p = 0.4), smoking (OR 2.55, 95% CI 0.27, 23.9; p = 0.4), and COPD (OR 0.32, 95% CI 0.03, 3.93; p = 0.4) were not predictive of postoperative SSO.

In our study, smoking, obesity, diabetes mellitus, and COPD did not predict 30-day follow-up wound complications after robotic retromuscular hernia repair. Given these findings, patients who are unable to optimize these risk factors may still be offered robotic retromuscular repair without increasing risk of postoperative SSO.