Cutting through the fat: a retrospective analysis of clinical outcomes, cost, and quality of life with the addition of panniculectomy to ventral hernia repair in overweight patients
Due to the increased prevalence of overweight patients with ventral hernia, abdominal wall reconstruction combining ventral hernia repair (VHR) with panniculectomy (VHR-PAN) in overweight patients is increasingly considered. We present a retrospective comparison between VHR-PAN and VHR alone in overweight patients by examining costs, clinical outcomes, and quality of life (QoL).
Patients with body mass index (BMI) > 25.0 kg/m2 underwent VHR-PAN or VHR alone between September 2015 and May 2017 with a single surgeon and were matched into cohorts by BMI and age (n = 24 in each cohort). QoL was assessed using the Hernia-related Quality of Life Survey (HerQLes). Cost was assessed using billing data. Statistical analyses were performed using Fisher’s exact tests, Mann–Whitney U tests, and regression modeling.
Hernia defect size (p = 0.127), operative time (p = 0.140), mesh placement (p = 0.357), and recurrence rates (p = 0.156) did not vary significantly between cohorts at average follow up of one year. 60% of patients completed QoL surveys, with 61% net improvement in VHR-PAN postoperatively (p = 0.042) vs 36% in VHR alone (p = 0.054). Mean total hospitalization costs were higher for VHR alone (p = 0.019). Regression modeling showed no significant independent contribution of procedure performed due to differences in cost, wound complications, or hernia recurrence.
At mean follow up of 2 years, VHR-PAN patients reported a comparable increase in QoL to those who received VHR alone without significantly different cost and complication rates. Concurrent VHR-PAN may therefore be a safe approach for overweight patients presenting with hernia and excess abdominal skin.
KeywordsPanniculectomy Obesity Outcomes Quality of life Ventral hernia Incisional hernia
Quality of life
Ventral hernia repair
Ventral hernia repair with panniculectomy
Body mass index
Hernia-related quality of life survey
Surgical site occurrence
Surgical site infection
Ventral hernia working group
The authors thank Jeffrey I. Rohrbach, MSN, of the Division of Data and Analytics at the University of Pennsylvania Health System for his assistance preparing and analyzing relevant cost data and Jesse Y. Hsu, PhD, of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania for his consultation on statistical methodology and design.
John P. Fischer is a paid consultant for Gore, Integra LifeSciences, Bard, and Allergan.
Compliance with ethical standards
Conflict of interest
John P. Fischer is a paid consultant for Gore, Integra LifeSciences, Bard, and Allergan. The remaining authors have no conflict of interest to disclose.
This study was approved by the institutional review board, University of Pennsylvania, Philadelphia, PA, USA.
Human and animal rights
No experimental conditions were implemented in this retrospective review. No animals or human participants were directly involved in this study.
As this study was a retrospective review, patient informed consent was not required or obtained for this study. Data were fully anonymized to minimize risk of identification.
- 8.Ogden CL, Carroll MD, Kit BK, Flegal KM (2013) Prevalence of obesity among adults: United States, 2011–2012. NCHS Data Brief 131:1–8Google Scholar
- 12.Koolen PG, Ibrahim AM, Kim K, Sinno HH, Lee BT, Schneider BE, Jones DB, Lin SJ (2014) Patient selection optimization following combined abdominal procedures: analysis of 4925 patients undergoing panniculectomy/abdominoplasty with or without concurrent hernia repair. Plast Reconstr Surg 134(4):539e–550e. https://doi.org/10.1097/PRS.0000000000000519 CrossRefPubMedGoogle Scholar
- 14.Fischer JP, Tuggle CT, Wes AM, Kovach SJ (2014) Concurrent panniculectomy with open ventral hernia repair has added risk versus ventral hernia repair: an analysis of the ACS-NSQIP database. J Plast Reconstr Aesthet Surg 67(5):693–701. https://doi.org/10.1016/j.bjps.2014.01.021 CrossRefPubMedGoogle Scholar
- 16.Giordano S, Garvey PB, Baumann DP, Liu J, Butler CE (2017) Concomitant panniculectomy affects wound morbidity but not hernia recurrence rates in abdominal wall reconstruction: a propensity score analysis. Plast Reconstr Surg 140(6):1263–1273. https://doi.org/10.1097/PRS.0000000000003855 CrossRefPubMedGoogle Scholar
- 18.Shubinets V, Fox JP, Tecce MG, Mirzabeigi MN, Lanni MA, Kelz RR, Dumon KR, Kovach SJ, Fischer JP (2017) Concurrent panniculectomy in the obese ventral hernia patient: Assessment of short-term complications, hernia recurrence, and healthcare utilization. J Plast Reconstr Aesthet Surg 70(6):759–767. https://doi.org/10.1016/j.bjps.2017.01.001 CrossRefPubMedGoogle Scholar
- 20.Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215(5):635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412 CrossRefPubMedGoogle Scholar
- 21.Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217(6):974–982. https://doi.org/10.1016/j.jamcollsurg.2013.08.003 CrossRefPubMedGoogle Scholar
- 24.Madabhushi V, Plymale MA, Roth JS, Johnson S, Wade A, Davenport DL (2017) Concomitant open ventral hernia repair: what is the financial impact of performing open ventral hernia with other abdominal procedures concomitantly? Surg Endosc. https://doi.org/10.1007/s00464-017-5884-3 CrossRefPubMedGoogle Scholar
- 25.Zemlyak AY, Colavita PD, El Djouzi S, Walters AL, Hammond L, Hammond B, Tsirline VB, Getz S, Heniford BT (2012) Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. J Surg Res 177(2):387–391. https://doi.org/10.1016/j.jss.2012.06.029 CrossRefPubMedGoogle Scholar
- 26.Fischer JP, Basta MN, Krishnan NM, Wink JD, Kovach SJ (2016) A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg 137(2):647–659. https://doi.org/10.1097/01.prs.0000475775.44891.56 CrossRefPubMedGoogle Scholar