, Volume 23, Issue 5, pp 899–907 | Cite as

Impact of body mass index on minimally invasive ventral hernia repair: an ACS-NSQIP analysis

  • L. Owei
  • R. A. SwendimanEmail author
  • S. Torres-Landa
  • D. T. Dempsey
  • K. R. Dumon
Original Article
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia



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.


Laparoscopic 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.

Ethical approval

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

Informed consent was waived due to the de-identified nature of the American College of Surgeon NSQIP database.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of SurgeryOregon Health and Science UniversityPortlandUSA
  4. 4.Division of Gastrointestinal Surgery, Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA

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