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Chao GF, Ying L, Huang LC, Ma J, Ghiassi S, Gibbs KE, Nadzam G, Morton J, Duffy A, Zhou R. Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery. Surg Endosc 2025; 39:560-567. [PMID: 39433584 DOI: 10.1007/s00464-024-11252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/31/2024] [Indexed: 10/23/2024]
Abstract
BACKGROUND Robotic ventral hernia surgery may provide better patient outcomes. Whether it is provided equitably based on race remains unknown. METHODS We examined whether patients from the Abdominal Core Health Quality Collaborative who were Black had equitable access to robotic surgery for ventral hernia repair with permanent mesh compared to white counterparts from 2013 to 2023. We performed propensity-score matching to address confounding and then chi-squared testing to examine access to robotic, laparoscopic, and open approaches. Secondary outcomes included 30-day readmissions, complications, and death and 1- and 2-year hernia recurrence and quality of life measured by HerQLes Summary and PROMIS Pain T-Scores analyzed with chi-squared, Fisher exact, and Wilcoxon testing. RESULTS 2397 patients identified as Black, and 21,900 identified as white. Our propensity-score matched cohort included 2374 Black patients and 7122 white. Black and white groups had the same rates of laparoscopy (15% vs 15%). Patients who identified as Black were more likely to undergo robotic surgery (36% vs 32%). Open approach was 49% for Black and 53% for white (p = 0.005). For 30-day complications, we found Black patients were more likely to experience reoperation (2% vs 1%, p = 0.005) and less likely surgical site infection (1% vs 2%, p < 0.001). Hernia recurrence scores and perceived abdominal health based on HerQLes were not statistically significantly different. At 2 years, absolute reported T-Scores were higher for Black patients (median 40 (IQR 31-49) vs 36 (31-46), p = 0.031). CONCLUSIONS This is the first large-scale study examining access to robotic surgery, complications, and quality of life measures. We found patients who identified as Black were more likely than white counterparts to undergo robotic surgery, but they were more likely to require reoperation and had higher pain scores. Our data suggest equitable access still may not translate to equitable patient outcomes.
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Affiliation(s)
- Grace F Chao
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA.
| | - Lee Ying
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jianing Ma
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
| | - Karen E Gibbs
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
| | - Geoffrey Nadzam
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
| | - John Morton
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
| | - Andrew Duffy
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
| | - Randal Zhou
- Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520, USA
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LaGuardia JS, Milek D, Lebens RS, Chen DR, Moghadam S, Loria A, Langstein HN, Fleming FJ, Leckenby JI. A Scoping Review of Quality-of-Life Assessments Employed in Abdominal Wall Reconstruction. J Surg Res 2024; 295:240-252. [PMID: 38041903 DOI: 10.1016/j.jss.2023.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Surgeons use several quality-of-life instruments to track outcomes following abdominal wall reconstruction (AWR); however, there is no universally agreed upon instrument. We review the instruments used in AWR and report their utilization trends within the literature. METHODS This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines using the PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases. All published articles in the English language that employed a quality-of-life assessment for abdominal wall hernia repair were included. Studies which focused solely on aesthetic abdominoplasty, autologous breast reconstruction, rectus diastasis, pediatric patients, inguinal hernia, or femoral hernias were excluded. RESULTS Six hernia-specific tools and six generic health tools were identified. The Hernia-Related Quality-of-Life Survey and Carolinas Comfort Scale are the most common hernia-specific tools, while the Short-Form 36 (SF-36) is the most common generic health tool. Notably, the SF-36 is also the most widely used tool for AWR outcomes overall. Each tool captures a unique set of patient outcomes which ranges from abdominal wall functionality to mental health. CONCLUSIONS The outcomes of AWR have been widely studied with several different assessments proposed and used over the past few decades. These instruments allow for patient assessment of pain, quality of life, functional status, and mental health. Commonly used tools include the Hernia-Related Quality-of-Life Survey, Carolinas Comfort Scale, and SF-36. Due to the large heterogeneity of available instruments, future work may seek to determine or develop a standardized instrument for characterizing AWR outcomes.
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Affiliation(s)
- Jonnby S LaGuardia
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David Milek
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ryan S Lebens
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - David R Chen
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Shahrzad Moghadam
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Howard N Langstein
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan I Leckenby
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
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Abstract
Abdominal core health encompasses the stability and function of the abdominal core and associated quality of life. Interventions to maintain core health include surgical and non-surgical therapies that integrate the functional relatedness of the abdominal core components.
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Affiliation(s)
- Benjamin K Poulose
- Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Doan Hall N729, 410 West 10th Avenue, Columbus, OH 43210, USA.
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Grieve R, Hutchings A, Moler Zapata S, O’Neill S, Lugo-Palacios DG, Silverwood R, Cromwell D, Kircheis T, Silver E, Snowdon C, Charlton P, Bellingan G, Moonesinghe R, Keele L, Smart N, Hinchliffe R. Clinical effectiveness and cost-effectiveness of emergency surgery for adult emergency hospital admissions with common acute gastrointestinal conditions: the ESORT study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-132. [DOI: 10.3310/czfl0619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Background
Evidence is required on the clinical effectiveness and cost-effectiveness of emergency surgery compared with non-emergency surgery strategies (including medical management, non-surgical procedures and elective surgery) for patients admitted to hospital with common acute gastrointestinal conditions.
Objectives
We aimed to evaluate the relative (1) clinical effectiveness of two strategies (i.e. emergency surgery vs. non-emergency surgery strategies) for five common acute conditions presenting as emergency admissions; (2) cost-effectiveness for five common acute conditions presenting as emergency admissions; and (3) clinical effectiveness and cost-effectiveness of the alternative strategies for specific patient subgroups.
Methods
The records of adults admitted as emergencies with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction to 175 acute hospitals in England between 1 April 2010 and 31 December 2019 were extracted from Hospital Episode Statistics and linked to mortality data from the Office for National Statistics. Eligibility was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes, which were agreed by clinical panel consensus. Patients having emergency surgery were identified from Office of Population Censuses and Surveys procedure codes. The study addressed the potential for unmeasured confounding with an instrumental variable design. The instrumental variable was each hospital’s propensity to use emergency surgery compared with non-emergency surgery strategies. The primary outcome was the ‘number of days alive and out of hospital’ at 90 days. We reported the relative effectiveness of the alternative strategies overall, and for prespecified subgroups (i.e. age, number of comorbidities and frailty level). The cost-effectiveness analyses used resource use and mortality from the linked data to derive estimates of incremental costs, quality-adjusted life-years and incremental net monetary benefits at 1 year.
Results
Cohort sizes were as follows: 268,144 admissions with appendicitis, 240,977 admissions with cholelithiasis, 138,869 admissions with diverticular disease, 106,432 admissions with a hernia and 133,073 admissions with an intestinal obstruction. Overall, at 1 year, the average number of days alive and out of hospitals at 90 days, costs and quality-adjusted life-years were similar following either strategy, after adjusting for confounding. For each of the five conditions, overall, the 95% confidence intervals (CIs) around the incremental net monetary benefit estimates all included zero. For patients with severe frailty, emergency surgery led to a reduced number of days alive and out of hospital and was not cost-effective compared with non-emergency surgery, with incremental net monetary benefit estimates of –£18,727 (95% CI –£23,900 to –£13,600) for appendicitis, –£7700 (95% CI –£13,000 to –£2370) for cholelithiasis, –£9230 (95% CI –£24,300 to £5860) for diverticular disease, –£16,600 (95% CI –£21,100 to –£12,000) for hernias and –£19,300 (95% CI –£25,600 to –£13,000) for intestinal obstructions. For patients who were ‘fit’, emergency surgery was relatively cost-effective, with estimated incremental net monetary benefit estimates of £5180 (95% CI £684 to £9680) for diverticular disease, £2040 (95% CI £996 to £3090) for hernias, £7850 (95% CI £5020 to £10,700) for intestinal obstructions, £369 (95% CI –£728 to £1460) for appendicitis and £718 (95% CI £294 to £1140) for cholelithiasis. Public and patient involvement translation workshop participants emphasised that these findings should be made widely available to inform future decisions about surgery.
Limitations
The instrumental variable approach did not eliminate the risk of confounding, and the acute hospital perspective excluded costs to other providers.
Conclusions
Neither strategy was more cost-effective overall. For patients with severe frailty, non-emergency surgery strategies were relatively cost-effective. For patients who were fit, emergency surgery was more cost-effective.
Future work
For patients with multiple long-term conditions, further research is required to assess the benefits and costs of emergency surgery.
Study registration
This study is registered as reviewregistry784.
Funding
This project was funded by the National Institute for Health and Care Research (IHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Silvia Moler Zapata
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen O’Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David G Lugo-Palacios
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Cromwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Tommaso Kircheis
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Claire Snowdon
- Department for Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Charlton
- Patient ambassador, National Institute for Health and Care Research, Southampton, UK
| | - Geoff Bellingan
- Intensive Care Medicine, University College London, London, UK
- NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London, London, UK
| | - Ramani Moonesinghe
- Centre for Perioperative Medicine, University College London Hospitals, London, UK
| | - Luke Keele
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Smart
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Robert Hinchliffe
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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Santos DA, Zhang L, Do KA, Bednarski BK, Robinson Ledet C, Limmer A, Gibson H, You YN. Chemotherapy and Abdominal Wall Closure Technique Increase the Probability of Postoperative Ventral Incisional Hernia in Patients With Colon Cancer. Am Surg 2023; 89:98-107. [PMID: 33877925 DOI: 10.1177/00031348211011149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chemotherapy is associated with postoperative ventral incisional hernia (PVIH) after right hemicolectomy (RHC) for colon cancer, and abdominal wall closure technique may affect PVIH. We sought to identify clinical predictors of PVIH. METHODS We retrospectively analyzed patients who underwent RHC for colon cancer from 2008-2018 and later developed PVIH. Time to PVIH was analyzed with Kaplan-Meier analysis, clinical predictors were identified with multivariable Cox proportional hazards modeling, and the probability of PVIH given chemotherapy and the suture technique was estimated with Bayesian analysis. RESULTS We identified 399 patients (209 no adjuvant chemotherapy and 190 adjuvant chemotherapy), with an overall PVIH rate of 38%. The 5-year PVIH rate was 55% for adjuvant chemotherapy, compared with 38% for none (log-rank P < .05). Adjuvant chemotherapy (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.18-2.31, P < .01), age (HR .99, 95% CI .97-1.00, P < .01), body mass index (HR 1.02, 95% CI 1.00-1.04, P < .01), and neoadjuvant chemotherapy (HR 1.92, 95% CI 1.21-3.00, P < .01) were independently associated with PVIH. Postoperative ventral incisional hernia was more common overall in patients who received adjuvant chemotherapy (46% compared with 30%, P < .01). In patients who received adjuvant chemotherapy, the probability of PVIH for incision closure with #1 running looped polydioxanone was 42%, compared with 59% for incision closure with #0 single interrupted polyglactin 910. DISCUSSION Exposure to chemotherapy increases the probability of PVIH after RHC, and non-short stitch incision closure further increases this probability, more so than age or body mass index. The suture technique deserves further study as a modifiable factor in this high-risk population.
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Affiliation(s)
- David A Santos
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Liangliang Zhang
- Department of Biostatistics, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kim-Anh Do
- Department of Biostatistics, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brian K Bednarski
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Celia Robinson Ledet
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angela Limmer
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heather Gibson
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y Nancy You
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wehrle CJ, Shukla P, Miller BT, Blake KE, Prabhu AS, Petro CC, Krpata DM, Beffa LR, Tu C, Rosen MJ. Incisional hernia rates following midline laparotomy in the obese patient: a retrospective review. Hernia 2022; 27:557-563. [DOI: 10.1007/s10029-022-02688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
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7
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Is There Indication for the Use of Biological Mesh in Cancer Patients? J Clin Med 2022; 11:jcm11206035. [PMID: 36294356 PMCID: PMC9605183 DOI: 10.3390/jcm11206035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2022] Open
Abstract
Up to 28% of all patients who undergo open surgery will develop a ventral hernia (VH) in the post-operative period. VH surgery is a debated topic in the literature, especially in oncological patients due to complex management. We searched in the surgical database of the Hepatobiliary Unit of the National Cancer Institute of Naples “G. Pascale Foundation” for all patients who underwent abdominal surgery for malignancy from January 2010 to December 2018. Our surgical approach and our choice of mesh for VH repair was planned case-by-case. We selected 57 patients that fulfilled our inclusion criteria, and we divided them into two groups: biological versus synthetic prosthesis. Anterior component separation was used in 31 patients (54.4%) vs. bridging procedure in 26 (45.6%). In 41 cases (71.9%), we used a biological mesh while a synthetic one was adopted in the remaining patients. Of our patients, 57% were male (33 male vs. 24 female) with a median age of 65 and a mean BMI of 30.8. We collected ventral hernia defects from 35 cm2 to 600 cm2 (mean 205.2 cm2); 30-day complications were present in 24 patients (42.1%), no 30-day mortality was reported, and 21 patients had a recurrence of pathology during study follow-up. This study confirms VH recurrence risk is not related with the type of mesh but is strongly related with BMI and type of surgery also in oncological patients.
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8
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Calibration of Hernia-Specific Patient-Reported Outcome Measures. J Surg Res 2022; 276:182-188. [DOI: 10.1016/j.jss.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/20/2022]
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Onyekaba G, Mauch JT, Patel V, Broach RB, Thrippleton S, Fischer JP. The Abdominal Hernia-Q: a critical analysis of the components that impact quality-of-life. Hernia 2022; 26:839-846. [PMID: 34338937 DOI: 10.1007/s10029-021-02475-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Ventral hernias (VH) are a common surgical problem associated with significant morbidity. While assessment tools have examined quality-of-life (QoL), the relative change in specific domains of hernia-related QoL measures from pre- to post-operative period has yet to be comprehensively examined. Using the Abdominal Hernia-Q (AHQ), this study aims to assess the impact of ventral hernia repair (VHR) on key components of QoL. METHODS A retrospective chart review was conducted of patients undergoing VHR between September 2017 and September 2019 who had completed at least one pre- and post-operative AHQ. Post-operative intervals were created to capture AHQ responses around standard follow-up visits (< 1.5 months, 1.5-4.5 months, 4.5-11 months, and 11 + months) and scores were statistically analyzed. RESULTS A total of 136 patients were included, with an average age of 54.8 years at the time of VHR. Compared to the pre-operative period, the appearance score increased significantly (p < 0.05). The physical domain score increased from < 1.5 month to the 1.5-4.5 month period (p = 0.03) and remained significantly higher in later time period. The appearance score decreased from the 1.5-4.5 month to 4.5-11 month period (p = 0.05). CONCLUSIONS VHR leads to a sustained multi-dimensional increase in hernia-specific QoL measures during the post-operative course driven by early positive changes in appearance and sustained physical functioning. The initial increase in QoL is mainly driven by an improvement in appearance, while the sustained increase may be due to restored physical function.
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Affiliation(s)
- G Onyekaba
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J T Mauch
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - V Patel
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R B Broach
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - S Thrippleton
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - J P Fischer
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA.
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Lamm R, Olson MA, Palazzo F. Are perioperative outcomes in cancer-related ventral incisional hernia repair worse than in the general population? An Abdominal Core Health Quality Collaborative (ACHQC) database study. Hernia 2022; 26:1169-1177. [PMID: 35486185 DOI: 10.1007/s10029-022-02618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Patients with a history of cancer-related abdominal surgery undergoing incisional hernia repair (IHR) are highly heterogenous and increasingly prevalent. We explored whether cancer surgery should be considered an independent risk factor for worse IHR perioperative outcomes. METHODS Patients undergoing IHR between 2018 and 2020 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Regression models were used to assess associations between cancer operation history and 30 d surgical site occurrences-exclusive of infection (SSO-EIs), surgical site infections (SSIs), reoperations, time to recurrence, and quality of life (QoL) scores. Cancer cohort subgroup analysis was performed for operative approach and mesh location. RESULTS 8019 patients who underwent IHR were identified in the ACHQC, 1321 of which had a history of cancer operation. Cancer cohort patients were more likely to be older, males with a higher ASA status and lower BMI, and have longer and wider hernias (p < 0.001). After adjusting for confounding, the cancer cohort was less likely to experience SSO-EIs (OR 0.74, 95% CI 0.59-0.94 p = 0.0092) and showed lower odds of SSIs, reoperations, and recurrence (SSI OR 0.7, 95% CI 0.47-1.05, p = 0.0542; reoperation OR 0.66, 95% CI 0.37-1.17, p = 0.1002; recurrence OR 0.8, 95% CI 0.63-1.02, p = 0.08). There was no difference in postoperative QoL scores between cohorts. There were also no differences in perioperative or QoL outcomes within the cancer cohort based on operative approach or mesh location. CONCLUSION These data show no evidence that history of cancer operation predisposes patients to worse incisional hernia repair perioperative or quality of life outcomes.
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Affiliation(s)
- R Lamm
- Department of Surgery, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA.
| | - M A Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - F Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
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12
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Haisley KR, Vadlamudi C, Gupta A, Collins CE, Renshaw SM, Poulose BK. Greatest Quality of Life Improvement in Patients With Large Ventral Hernias: An Individual Assessment of Items in the HerQLes Survey. J Surg Res 2021; 268:337-346. [PMID: 34399356 DOI: 10.1016/j.jss.2021.06.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ventral hernia repair (VHR) has been shown to improve overall quality of life (QOL) by the validated 12-question Hernia-Related Quality-of-Life survey (HerQLes). However, which specific aspects of quality of life are most affected by VHR have not been formally investigated. METHODS Through retrospective analysis of the Abdominal Core Health Quality Collaborative national database, we measured the change in each individual component of the HerQLes questionnaire from a pre-operative baseline assessment to one-year postoperatively in VHR patients. RESULTS In total, 1,875 VHR patients had completed both pre- and post-operative questionnaires from 2014-2018. They were predominately Caucasian (92.3%), 57.9 ± 12.4 Y old, and evenly gender split (50.5% male, 49.5% female, P = 0.31). Most operations were performed open (80.5%) with fewer laparoscopic (7.5%) or robotic cases (12.1%). For each of the 12 individual categories, improvement in QOL from baseline to 1-Y was found to be statistically significant (P < 0.0001). This held true with subgroup analysis of small (<2 cm), medium (2-6 cm), and large (>6 cm) hernias (P < 0.0001), though a larger improvement was seen in 8 of 12 components in hernias >6 cm (P < 0.001). Operative approach did not carry a significant effect except in medium hernias (2-6 cm), where an open approach saw a greater improvement in the "accomplish less at work" item (P = 0.02). CONCLUSIONS VHR is associated with improvement in each of the 12 components of QOL measured in the HerQLes questionnaire, regardless of the size of their hernia. The amount of improvement, however, may be dependent on hernia size and approach.
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Affiliation(s)
- Kelly R Haisley
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio.
| | | | - Anand Gupta
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Courtney E Collins
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Savanah M Renshaw
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Benjamin K Poulose
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio
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Tang H, Liu D, Guo Y, Zhang H, Li Y, Peng X, Wang Y, Jiang D, Zhang L, Wang Z. A New Device for Measuring Abdominal Wall Tension and Its Value in Screening Abdominal Infection. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:119-131. [PMID: 33911903 PMCID: PMC8075309 DOI: 10.2147/mder.s291407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/19/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This study is the largest clinical study of noninvasive Abdominal wall tension (AWT) measurement with a tensiometer to date. It also initially applies a polynomial regression equation to analyze the correlation between AWT measurement and intravesical pressure (IVP) measurement and remarkably finds interesting changes between different IVP intervals and AWT. METHODS Critically ill patients who were treated in the intensive care unit (ICU) of Daping Hospital, Army Medical University, from August 30, 2018, to June 30, 2020, and met the inclusion criteria were prospectively included in this study. The patients were divided into an intra-abdominal hypertension group and a non-intra-abdominal hypertension group and an abdominal infection group and no abdominal infection group. AWT and IVP were measured at 9 points on the abdominal wall on the first day after admission to the ICU. The correlations between AWTs and IVP were analyzed, and the role of AWT in the diagnosis of complications of abdominal infection and the prediction of adverse prognosis were analyzed. RESULTS A total of 127 patients were included. The average AWT and IVP were 2.77±0.38 N/mm and 12.31±7.01 mmHg, respectively, on the first day of admission. There was a positive correlation between AWT and IVP (correlation coefficient r = 0.706, p < 0.05). The polynomial regression model was AWT= -1.616×10-3 IVP2 +8.323×10-2 IVP+2.094. The cutoff value of the sensitivity and specificity of AWT for the diagnosis of abdominal infection was 2.57 N/mm. Furthermore, AWT = 2.57 N/mm had the best diagnostic efficiency, which was better than that of IAH and lactate. CONCLUSION There was a correlation between AWT and IVP. AWT measurement was helpful in the diagnosis of IAH and abdominal infection complications and can therefore serve as a new method for the clinical diagnosis of IVP and abdominal infection.
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Affiliation(s)
- Hao Tang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Dong Liu
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Yong Guo
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Huayu Zhang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Yang Li
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Xiaoyu Peng
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Yaoli Wang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Dongpo Jiang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Lianyang Zhang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Zhengguo Wang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
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Harji D, Thomas C, Antoniou SA, Chandraratan H, Griffiths B, Henniford BT, Horgan L, Köckerling F, López-Cano M, Massey L, Miserez M, Montgomery A, Muysoms F, Poulose BK, Reinpold W, Smart N. A systematic review of outcome reporting in incisional hernia surgery. BJS Open 2021; 5:6220250. [PMID: 33839746 PMCID: PMC8038267 DOI: 10.1093/bjsopen/zrab006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 01/13/2023] Open
Abstract
Background The incidence of incisional hernia is up to 20 per cent after abdominal surgery. The management of patients with incisional hernia can be complex with an array of techniques and meshes available. Ensuring consistency in reporting outcomes across studies on incisional hernia is important and will enable appropriate interpretation, comparison and data synthesis across a range of clinical and operative treatment strategies. Methods Literature searches were performed in MEDLINE and EMBASE (from 1 January 2010 to 31 December 2019) and the Cochrane Central Register of Controlled Trials. All studies documenting clinical and patient-reported outcomes for incisional hernia were included. Results In total, 1340 studies were screened, of which 92 were included, reporting outcomes on 12 292 patients undergoing incisional hernia repair. Eight broad-based outcome domains were identified, including patient and clinical demographics, hernia-related symptoms, hernia morphology, recurrent incisional hernia, operative variables, postoperative variables, follow-up and patient-reported outcomes. Clinical outcomes such as hernia recurrence rates were reported in 80 studies (87 per cent). A total of nine different definitions for detecting hernia recurrence were identified. Patient-reported outcomes were reported in 31 studies (34 per cent), with 18 different assessment measures used. Conclusions This review demonstrates the significant heterogeneity in outcome reporting in incisional hernia studies, with significant variation in outcome assessment and definitions. This is coupled with significant under-reporting of patient-reported outcomes.
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Affiliation(s)
- D Harji
- Northern Surgical Trainees Research Association (NoSTRA), Northern Deanery, Newcastle Upon Tyne, UK
| | - C Thomas
- Northern Surgical Trainees Research Association (NoSTRA), Northern Deanery, Newcastle Upon Tyne, UK
| | - S A Antoniou
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - H Chandraratan
- Notre Dame University, General Surgery, Murdoch, Western Australia, Australia
| | - B Griffiths
- Newcastle Surgical Education, Newcastle Upon Tyne, UK
| | - B T Henniford
- Division of Gastrointestinal and Minimally Invasive Surgery Carolinas Medical Center, Charlotte, North Carolina, USA
| | - L Horgan
- Upper Gastrointestinal Surgical Department, Northumbria Healthcare NHSFT, North Shields, UK
| | - F Köckerling
- Department of Surgery and Centre for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - M López-Cano
- Abdominal Wall Surgery Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - L Massey
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Muysoms
- Department of Surgery, Maria Middelares, Ghent, Belgium
| | - B K Poulose
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Reinpold
- Department of Surgery and Reference Hernia Centre, Gross Sand Hospital Hamburg, Hamburg, Germany
| | - N Smart
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
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15
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Grove TN, Muirhead LJ, Parker SG, Brogden DRL, Mills SC, Kontovounisios C, Windsor ACJ, Warren OJ. Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools. Hernia 2021; 25:491-500. [PMID: 32415651 PMCID: PMC8055629 DOI: 10.1007/s10029-020-02210-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Abdominal wall herniation (AWH) is an increasing problem for patients, surgeons, and healthcare providers. Surgical-site specific outcomes, such as infection, recurrence, and mesh explantation, are improving; however, successful repair still exposes the patient to what is often a complex major operation aimed at improving quality of life. Quality-of-life (QOL) outcomes, such as aesthetics, pain, and physical and emotional functioning, are less often and less well reported. We reviewed QOL tools currently available to evaluate their suitability. METHODS A systematic review of the literature in compliance with PRISMA guidelines was performed between 1st January 1990 and 1st May 2019. English language studies using validated quality-of-life assessment tool, whereby outcomes using this tool could be assessed were included. RESULTS Heterogeneity in the QOL tool used for reporting outcome was evident throughout the articles reviewed. AWH disease-specific tools, hernia-specific tools, and generic tools were used throughout the literature with no obviously preferred or dominant method identified. CONCLUSION Despite increasing acknowledgement of the need to evaluate QOL in patients with AWH, no tool has become dominant in this field. Assessment, therefore, of the impact of certain interventions or techniques on quality of life remains difficult and will continue to do so until an adequate standardised outcome measurement tool is available.
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Affiliation(s)
- T N Grove
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - L J Muirhead
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
| | - S G Parker
- Abdominal Wall Reconstruction Unit, Department of Surgery, University College Hospital, London, UK
| | - D R L Brogden
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - S C Mills
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - C Kontovounisios
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK.
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK.
- Department of Surgery, Royal Marsden Hospital, London, UK.
| | | | - O J Warren
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
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16
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Abstract
Ventral and incisional hernias in obese patients are particularly challenging. Suboptimal outcomes are reported for elective repair in this population. Preoperative weight loss is ideal but is not achievable in all patients for a variety of reasons, including access to bariatric surgery, poor quality of life, and risk of incarceration. Surgeons must carefully weigh the risk of complications from ventral hernia repair with patient symptoms, the ability to achieve adequate weight loss, and the risks of emergency hernia repair in obese patients.
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