Impact of body mass index on minimally invasive ventral hernia repair: an ACS-NSQIP analysis
Body mass index (BMI) ≥ 35 kg/m2 is a known independent risk factor for complications following open ventral hernia repair (VHR). We sought to examine the relationship between BMI and minimally invasive VHR.
The ACS-NSQIP database was queried for all patients age ≥ 18 years undergoing minimally invasive VHR (2005–2015). Patients were stratified into seven BMI classes: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5–24.9), overweight (25–29.9), obese (30–34.5), severely obese (35–39.9), morbidly obese (40–49.9), and super obese (BMI ≥ 50), as well as by hernia type (reducible vs. strangulated) and time of repair (initial vs. recurrent). Multivariate logistic regression was employed to assess the risk of complication by BMI class.
A total of 55,180 patients met inclusion criteria, and 61.4% had a BMI > 30 kg/m2. When stratified by BMI class, we found significant differences in age, gender, race, comorbidities, and pre-operative characteristics across groups. The overall complication rate was 4.0%, ranging from 3.0% for normal BMI patients, to 6.9% for patients with a BMI ≥ 50 kg/m2. Recurrent repairs and strangulated hernias both demonstrated higher complication rates. All complications (surgical and medical) were significantly associated with BMI class after adjustment (p < 0.0001). Patients with a BMI ≥ 50 kg/m2 had a 1.4 times greater risk for complications than patients with normal BMIs (18–24.9 kg/m2, p = 0.01).
BMI ≥ 50 kg/m2 was determined to be an independent risk factor for surgical and medical complications after minimally invasive VHR.
KeywordsLaparoscopic hernia repair NSQIP Obesity Body mass index Obesity paradox
Ventral hernia repair
Body mass index
American College of Surgeons National Surgical Quality Improvement Program
Surgical site infection
American Society of Anesthesiologists
Chronic obstructive pulmonary disease
Compliance with ethical standards
Conflict of interest
This manuscript has not been previously published and is not under consideration in the same or substantially similar form in any other journal. The above authors are qualified for authorship and have no conflicts of interest or financial disclosures.
This study was approved by the Institutional Review Board at the University of Pennsylvania.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was waived due to the de-identified nature of the American College of Surgeon NSQIP database.
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