The Effect of Obesity on Outcomes of Ventral Hernia Repair: A Propensity Score Matching Analysis

Neil P. Borad and Aziz M. Merchant


Purpose: To determine whether overweight body mass index (BMI) impacts adverse 30-day outcomes in ventral hernia repair (VHR).
Study design: Observational retrospective cohort study of a prospectively collected database.
Methods: Data from the National Surgical Quality Improvement Program were extracted for patients undergoing VHR from 2005-2014. Patients were stratified into five BMI (kg/m2 ) categories [normal (18.5–24.9), pre-obese (25.0– 29.9), obese I (30.0–34.9), obese II (35.0–39.9), and obese III (≥ 40)] and were compared for significant differences in pre-operative characteristics. Propensityscore matching evenly distributed confounding covariates amongst BMI categories. Multivariate logistic regression was used before and after matching to isolate the impact of BMI on the primary outcome of any 30-day morbidity and secondary outcomes of 30-day wound-, respiratory complications, and mortality.
Results: 84.1% of VHR patients in the cohort (168,214) were overweight (BMI ≥ 25). In the unmatched analyses, only obese I-III patients showed increased odds of any 30-day morbidity while every overweight BMI category was associated positively with 30-day wound complications. After propensityscore matching, every overweight category showed increased odds for both any 30-day complication [ORPreobese 1.12, p = 0.008; ORobeseIII 1.64, p < 0.0001] as well as for wound-based complication in a dose-dependent manner.
Conclusions and clinical relevance: Increased BMI is a modifiable risk factor for adverse surgical outcomes in patients undergoing VHR. With obesity rates on the rise, these findings can be used by surgeons to assist in the selection and evaluation of obese patients being considered for VHR and more importantly, be used to educate patients presenting with VHR about the risks of elective repair

Published on: March 13, 2017
doi: 10.17756/jocd.2016-003
Citation: Borad NP, Merchant AM. 2017. The Effect of Obesity on Outcomes of Ventral Hernia Repair: A Propensity Score Matching Analysis. J Obes Chronic Dis 1(1): 6-14.