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Effect of improved preoperative activity levels and smoking cessation on ventral hernia repair outcomes
Emily Flom1, Lee Ying1, Cassie Hennessy2
1Department of Surgery, Yale School of Medicine, 20 York Street, New Haven, CT, 06511, USA.
Introduction:
Preoperative patient factors, including baseline physical activity level and smoking status, play an important role in surgical outcomes. This study aims to evaluate whether improved preoperative activity level and smoking cessation decrease surgical complications and improve outcomes for high-risk patients after ventral hernia repair.
Methods:
Utilizing the Abdominal Core Health Quality Collaborative, a retrospective cohort analysis was conducted. Adult patients undergoing ventral hernia repair who participated in smoking cessation or preoperative exercise were included. Multi-variate logistic regression analyses were used to assess how preoperative exercise and smoking cessation affected primary outcomes including length of stay, 30-day readmission, surgical site infection (SSI), surgical site occurrences (SSO), and surgical site occurrence requiring procedural intervention (SSOPI).
Results:
Among 17,819 patients, in patients with ASA class 2 or higher, any level preoperative exercise regimens improved outcomes. For ASA 2 patients, sporadic and intense exercises were associated with reduced odds of 30-day readmission. Among ASA 3 patients, moderate and intense exercise significantly reduced the risk of SSI. Increasing exercise intensity also demonstrated a trend toward reduced SSO and SSOPI. Smoking cessation within one year prior to surgery was not associated with significant differences in postoperative outcomes compared with active smokers.
Conclusion:
Preoperative exercise improved outcomes after ventral hernia repair, particularly among higher-risk patients (ASA class 2 and above). Specifically, preoperative exercise decreased odds of 30-day readmission, surgical site infections, and surgical site occurrences. These findings suggest that structured preoperative exercise programs may represent an effective, modifiable strategy to improve outcomes in patients undergoing ventral hernia repair. Further research is needed to identify which patient populations derive the greatest benefit from targeted exercise and smoking cessation interventions.
