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Preoperative Optimization for Ventral Hernia Repair: Augmented Evidence Review
Fathi Moustafa1, Aldo Fafaj2, Clayton Petro1
1Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
Summary
Preoperative optimization for ventral hernia repair shows obesity increases wound complications, while smoking raises surgical site issues. Diabetes status had no significant impact, with surgeons favoring individualized approaches for risk factors.
Area of Science:
- Surgical outcomes research
- Evidence-based medicine
- Health services research
Background:
- Preoperative optimization is recommended for ventral hernia repair, but the impact of individual risk factors like obesity, diabetes, and smoking on outcomes is unclear.
- Understanding these associations is crucial for refining patient preparation protocols.
- This study investigates the link between key risk factors and postoperative results in ventral hernia repair.
Purpose of the Study:
- To evaluate the association of obesity, diabetes mellitus, and smoking with postoperative outcomes after ventral hernia repair.
- To compare these findings with current surgeon practices and existing medical literature.
- To inform preoperative optimization strategies for patients undergoing ventral hernia repair.
Main Methods:
- An augmented evidence review (AER) integrated three streams: retrospective analysis of the Abdominal Core Health Quality Collaborative database, a survey of practicing surgeons, and an AI-driven literature review.
- The AER addressed the question: "What are the key components of preoperative patient optimization for ventral hernia repair?"
- Each evidence stream was analyzed independently before integration.
Main Results:
- Obesity correlated with increased wound complications but not systemic ones. Diabetes status and control did not significantly affect postoperative complications.
- Smoking was linked to higher rates of surgical site occurrence and pneumonia.
- Surgeons generally consider these risk factors important, with a preference for individualized management of obesity and smoking, and defined thresholds for glycemic control.
Conclusions:
- While statistically significant associations exist between some risk factors (obesity, smoking) and specific postoperative outcomes, their clinical significance is largely surgeon-dependent.
- Surgeons' practices reflect an individualized approach for managing obesity and smoking, with less emphasis on defined thresholds for diabetes.
- The study highlights the nuanced role of surgeon judgment in interpreting risk factors for preoperative optimization in ventral hernia repair.
