The Components Separation Technique Increases 30-Day Adverse Outcomes in Patients Undergoing Anterior Abdominal...

Area of Science:

• Abdominal surgery
• Hernia repair outcomes
• Surgical techniques

Background:

• Component separation techniques (CST) are used in anterior abdominal hernia repair (AAHR) to improve closure and reduce recurrence.
• New CPT codes allow for analysis of CST's impact on AAHR outcomes, considering defect size.

Purpose of the Study:

• To evaluate the influence of CST on 30-day outcomes following elective anterior abdominal hernia repair (AAHR) for defects larger than 3 cm.
• To determine if CST is associated with increased morbidity, mortality, and other adverse events.

Main Methods:

• Analysis of 24,478 elective AAHR cases from the 2023 ACS NSQIP database for defects >3 cm.
• Comparison of outcomes between patients who underwent CST (CPT 15734) and those who did not, with adjustment for defect size and risk variables.

Main Results:

• 9.1% of patients underwent CST, more common in open repairs, large defects, recurrent, and incarcerated hernias.
• CST was associated with increased operative time (75 min laparoscopic, 68 min open), major morbidity (4.4% vs 11.8%), and surgical site infection (2.5% vs 6.0%).
• Risk-adjusted analysis showed CST increased odds of morbidity (OR 1.38) and trended towards increased SSI (OR 1.22). Reoperation, readmission, and 30-day mortality also significantly increased with CST.

Conclusions:

• Ventral hernia repair utilizing component separation techniques is associated with significantly higher 30-day adverse outcomes compared to repairs without CST.
• The increased risks include longer operative times, higher rates of morbidity, surgical site infections, reoperations, readmissions, and mortality.