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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, United States.
Background:
Preoperative optimization is widely recommended for patients undergoing ventral hernia repair. However, the clinical impact of individual risk factors remains uncertain. This study aimed to evaluate the association of obesity, diabetes mellitus, and smoking with postoperative outcomes and to compare these findings with surgeon practices and existing literature.
Methods:
The augmented evidence review (AER) was performed using 3 evidence streams to answer the unified question: "What are the key components of preoperative patient optimization for ventral hernia repair?" Empiric evidence was gathered using a retrospective analysis of the Abdominal Core Health Quality Collaborative database. Social media evidence was gathered by surveying practicing surgeons via the International Hernia Collaboration social media group. Artificial intelligence (AI) evidence was obtained from the OpenEvidence platform, which performed a data-driven literature review. Each evidence stream was analyzed independently before integrating it in the AER.
Results:
Obesity was associated with increased wound complications, but showed no significant association with systemic complications. Diabetes status and glycemic control were not associated with postoperative complications. Smoking was associated with increased surgical site occurrence and pneumonia. Survey results demonstrated that most surgeons consider these risk factors important. However, implementation varied, with individualized approaches favored for obesity and smoking, whereas defined thresholds were used for glycemic control. AI-derived evidence demonstrated similar heterogeneity.
Conclusion:
The evaluated risk factors demonstrated modest differences in postoperative outcomes, some of which were statistically significant. However, the clinical significance is mainly determined by the surgeon, as reflected by our survey. Most surgeons favored an individualized approach for obesity, followed by smoking, and less so for diabetes mellitus.
