Preoperative Optimization for Ventral Hernia Repair: Augmented Evidence Review

Area of Science:

• Surgical outcomes research
• Evidence-based medicine
• Health services research

Background:

• Preoperative optimization is recommended for ventral hernia repair, but individual risk factor impact is unclear.
• Key risk factors include obesity, diabetes mellitus, and smoking.
• Understanding these factors' association with outcomes is crucial for patient care.

Purpose of the Study:

• To evaluate the association of obesity, diabetes mellitus, and smoking with postoperative outcomes in ventral hernia repair.
• To compare these associations with surgeon practices and existing literature.
• To inform preoperative optimization strategies.

Main Methods:

• Augmented Evidence Review (AER) using empiric, social media, and AI evidence streams.
• Retrospective analysis of the Abdominal Core Health Quality Collaborative database.
• Surgeon surveys via the International Hernia Collaboration social media group.
• AI-driven literature review via OpenEvidence platform.

Main Results:

• Obesity linked to increased wound complications; no significant systemic complication association.
• Diabetes status and glycemic control showed no association with postoperative complications.
• Smoking associated with increased surgical site occurrence and pneumonia.
• Surgeons perceive these factors as important, with varied implementation strategies, favoring individualized approaches for obesity and smoking.

Conclusions:

• Evaluated risk factors show modest, sometimes statistically significant, differences in postoperative outcomes.
• Clinical significance is largely surgeon-dependent, with a preference for individualized management.
• Surgeons favor individualized approaches for obesity and smoking over defined thresholds for glycemic control.