Preoperative functional health status impacts outcomes after ventral hernia repair

Abstract

Associated with the aging population is an increase in comorbidities and a decrease in the ability to perform basic daily activities. This is tracked within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) as a patient's preoperative functional health status. Our goal was to evaluate the impact of preoperative functional status upon outcomes after ventral hernia repair. We reviewed all cases of patients that underwent ventral hernia repair from 2005 to 2010 in the ACS-NSQIP database. Patients were identified based on selected Current Procedural Terminology codes and grouped based on functional status as listed in the ACS-NSQIP database - independent, partially dependent, and totally dependent. Preoperative and operative variables were recorded for all patients. Clinical risk factors and short-term outcomes between groups were compared. Multivariable logistic regression was used to adjust for age, wound class, American Society of Anesthesiologists class, and case relative value units. A total of 76,397 patients were identified: 74,785 were independent (97.9%), 1,317 partially dependent (1.7%), and 295 totally dependent (0.4%). Totally dependent patients had an increased risk for all shortterm outcomes after ventral hernia repair: wound occurrence, pneumonia, pulmonary embolism, urinary tract infection, myocardial infarction, deep venous thrombosis, sepsis, return to the operating room, and death (P<0.001 for all).