Comparison Of Outcomes Of Laparoscopic And Open Ventral Hernia Repair In Obese Patients

ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS272

disruption (0.99%, 2005; 1.04%, 2006; 0.95%, 2007; 0.84%, 2009;p<0.0001), post-operative pneumonia (2.99% to 2.26%; p<0.0001),unplanned reintubations (2.43% to 2.03%; p<0.0001), ARF (0.78%to 0.71%; p<0.0001), UTI (2.91% to 2.27%; p<0.0001), graft failure(0.45% to 0.37%; p<0.0001), sepsis (3.65% to 2.88%; p<0.0001) andseptic shock (7.67% to 6.65%; p<0.0001). Other indicators of operativeperformance also improved over time: reduction in operative time,LOS and intra-operative PRBC transfusions (r ¼ -0.01, r ¼ -0.03and r<-0.01 respectively; p<0.0001). Conclusions: Enrollment inACSNSQIP parallels improvement across multiple important perfor-mance quality indicators, which are evident now only four years sinceits inception. This data confirms that increased participation inNSQIP is warranted due to improvements in surgical performanceand the potential for reduced healthcare costs.

CLINICAL TRIALS & OUTCOMES 4: BREAST,ENDOCRINE&HERNIASURGICALOUTCOMES

34.1. CanMesh Be Used In Clean-Contaminated And Contam-inated Ventral Hernia Repairs? Outcomes of 33,832Cases. J. J. Choi, N. C. Palaniappa, K. B. Dallas, T. B.Rudich, M. J. Colon, C. M. Divino; Mount Sinai School ofMedicine, New York, NY

Introduction: Ventral hernia repair with mesh is one of the mostcommon surgical procedures performed. The indications for usingmesh in clean contaminated or contaminated fields is controversialbecause of associated complications such as surgical site infections,fistula formation and prosthesis failure. Outcomes of repair ina clean-contaminated or grossly contaminated field deserve morestudy, given the frequency that such fields are encountered duringa hernia repair. The purpose of our study is to compare post-operativecomplications following ventral hernia repair with mesh in clean-contaminated and contaminatedfields.Methods:Weconducted a ret-rospective review of 33,832 patients who underwent a ventral herniarepair from 1/1/2005 to 4/4/2010 using the National Surgical QualityImprovement Program (NSQIP), and categorized the data based onfield contamination level (clean, clean-contaminated, or contami-nated). The post-operative complications that we studied were surgi-cal site infections (SSIs), wound disruption, pneumonia, graft/prosthesis/flap failure, sepsis, septic shock and the need for ven-tilation>48 hours. All statistical analysis was done using an odds ra-tio test with a 95% confidence interval. Results: Analysis of nationaldata showed that the odds of having one or more post-operative occur-rences were significantly greater in clean-contaminated cases con-taminated cases when compared to clean cases, with odds ratios of3.56 (3.25-3.89) and 5.05 (1.78-12.41) respectively. Moreover, whenwe analyzed individual post-operative occurrences, we found that rel-ative to clean cases, the odds ratio of superficial surgical site infections(SSIs), deep incisional SSIs, organ/space SSIs, wound disruption,

pneumonia, sepsis, septic shock, and being placed on a ventilator forover 48 hours were significantly higher in clean-contaminated cases.Conclusions:There is a significant increase of post-operative compli-cations in clean-contaminated and contaminated cases. Although theuse of mesh may be beneficial in clean ventral hernia repairs, thisstudy demonstrates that there is significant risk associated with itsuse in a field with any level of contamination.

34.2. Comparison Of Outcomes Of Laparoscopic And OpenVentral Hernia Repair In Obese Patients. O. Dolghi,V. M. Kothari, J. F. Reynoso, J. U. Unnirevi, E. M. Schmidt,D. Oleynikov; University of Nebraska Medical Center, Omaha,NE

Introduction:A largemulti-center studyonoutcomesof laparoscopicventral hernia repair in obese patients has not been performed. Thisstudy examines outcomes of laparoscopic ventral hernia repair(LVHR) in obese and non-obese patients and open ventral hernia re-pair (OVHR) in obese patients.Methods:This study is amulti-center,retrospective analysis of laparoscopic and open ventral hernia repairin non-obese and obese patients, defined by body mass index (BMI)greater than30.Four-yeardischargedata fromtheUniversityHealth-SystemConsortium(UHC)databasewasaccessedusing InternationalClassification of Diseases (ICD-9) codes between January 2006 andDecember2009.UHCisanallianceofmore than100academicmedicalcenters and nearly 200 affiliate hospitals. UHC’s Clinical Data Base /ResourceManager (CDB/RM)allowsmemberhospitals to comparepa-tient-level risk-adjusted outcomes for performance improvement pur-poses. Main outcome measures analyzed were mortality, morbidity,30-day readmission, intensive care unit (ICU) admission, length ofICU stay, overall length of hospital stay and costs. Results: In thegroup of obese patients 7,737 underwent OVHR and 843 underwentLVHR during the four-year period. A total of 2,385 non-obese patientsunderwent LVHR during the same period of time. When compared toobese patients who had OVHR obese patients who underwent LVHRshowed significantly lower mortality (0.12% LVHR obese vs. 1.06%OVHR obese; p<0.001), lower morbidity (19.1% LVHR obese vs.32.94% OVHR obese; p<0.001), reduced length of stay (4.1266. 17days LVHR obese vs. 8.01612. 89 days OVHR obese; p<0.001), re-duced costs ($16.193612.163 LVHR obese vs. $25,596638,466OVHR obese; p<0.001), and lower ICU admission rate (7.5% LVHRobese vs. 23.44% OVHR obese; p<0.001). Comparative analysis be-tween LVHR in obese patients and LVHR in non-obese patientsshowed no significant difference in the incidence in mortality (0.12%LVHR obese vs. 0.29% LVHR non-obese; p¼0.69), morbidity (19.1%LVHR obese vs. 17. 2% LVHR non-obese; p¼0.1880), length of stay(4.1266.17 days LVHR obese vs. 3.7464.98 days; p¼0.07) and 30-day readmission rate (3.1% LVHR obese vs. 3.1% LVHR non-obese;p ¼0.9078). However, ICU admission rate (7.5% LVHR obese vs. 5.2%LVHR non-obese; p¼0.022) and cost ($16,193612,163 LVHR obesevs. $14,543619,193 LVHR non-obese) were significantly increasedin the obese LVHR group. Conclusions: Obese patients undergoingLVHR have overall superior perioperative outcomes when comparedto obese patients undergoing OVHR. The diagnosis of obesity doesnot significantly affect perioperative surgical outcomes in LVHR.Lap-aroscopic ventral hernia repair in obese patients is safe and efficaciousand should be the procedure of choice for patients with BMI> 30.

34.3. Assessing Hernia Recurrence: Pitfalls in MeasurementStrategies. L. K. Altom,1,2 L. A. Graham,1 R. J. Deierhoi,1

C. D. Vick,1 C. W. Snyder,2 M. T. Hawn1,2; 1the Center forSurgical, Medical Acute Care Research and Transitions(C-SMART), Birmingham, AL; 2Section of GastrointestinalSurgery, Department of Surgery, University of Alabama AtBirmingham, Birmingham, AL

Introduction:Traditionally, studies looking at patient-reported out-comes report non-responder bias as a main study limitation. Thisstudy examines the factors associated with concordance between