Sarcopenia and outcomes in ventral hernia repair

a preliminary review

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Sarcopenia, or loss of muscle mass, is associated with increased morbidity and mortality in oncologic resections and several other major surgeries. Complex ventral hernia repairs (VHRs) and abdominal wall reconstruction are often performed in patients at high risk for morbidity and recurrence, though limited data exist on outcomes related to sarcopenia. We aimed to determine if sarcopenia is associated with worse outcomes in patients undergoing VHR. Methods: We reviewed patients undergoing VHRs from 2014 to 2015. Preoperative CT images were analyzed for cross-sectional muscle mass. Patients with and without sarcopenia underwent statistical analysis to evaluate differences in perioperative morbidity and hernia recurrence. Muscle indices were analyzed independently for outcomes. Results: 135 patients underwent VHR with/without fistula takedown, staged repairs or other concomitant procedures. 27% had sarcopenia (age 34–84, BMI 27–33, 62% male). Postoperative complications occurred in 43% of sarcopenic patients and 47% of non-sarcopenic patients (p = 0.70). Surgical site infections (SSI) were seen in 16% of sarcopenic patients compared to 29% without sarcopenia (p = 0.14). There was no difference in hernia recurrence between groups (p = 0.90). However, after adjusting for diabetes and BMI, a 10 cm2/m2 decrease in muscle index had 1.44 OR of postoperative complications (p < 0.05). Conclusions: Though prevalent in our population, sarcopenia was not associated with an increase in postoperative complications, surgical site occurences/infections, or hernia recurrence when previously published oncologic sarcopenia cutoffs were utilized. Previously established sarcopenia outcomes in malignancy may be attributable to an altered metabolic state that is not present in hernia repair patients. Larger-scale studies are recommended to establish new sarcopenia cutoffs for VHRs.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalHernia
DOIs
StateAccepted/In press - May 11 2018

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Ventral Hernia
Sarcopenia
Herniorrhaphy
Hernia
Surgical Wound Infection
Recurrence
Muscles
Morbidity
Abdominal Wall
Fistula

Keywords

  • Abdominal wall reconstruction
  • AWR
  • Sarcopenia
  • Ventral hernia repair
  • VHR

ASJC Scopus subject areas

  • Surgery

Cite this

Sarcopenia and outcomes in ventral hernia repair : a preliminary review. / Siegal, S. R.; Guimaraes, Alexander; Lasarev, M. R.; Martindale, Robert; Orenstein, Sean.

In: Hernia, 11.05.2018, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "Purpose: Sarcopenia, or loss of muscle mass, is associated with increased morbidity and mortality in oncologic resections and several other major surgeries. Complex ventral hernia repairs (VHRs) and abdominal wall reconstruction are often performed in patients at high risk for morbidity and recurrence, though limited data exist on outcomes related to sarcopenia. We aimed to determine if sarcopenia is associated with worse outcomes in patients undergoing VHR. Methods: We reviewed patients undergoing VHRs from 2014 to 2015. Preoperative CT images were analyzed for cross-sectional muscle mass. Patients with and without sarcopenia underwent statistical analysis to evaluate differences in perioperative morbidity and hernia recurrence. Muscle indices were analyzed independently for outcomes. Results: 135 patients underwent VHR with/without fistula takedown, staged repairs or other concomitant procedures. 27{\%} had sarcopenia (age 34–84, BMI 27–33, 62{\%} male). Postoperative complications occurred in 43{\%} of sarcopenic patients and 47{\%} of non-sarcopenic patients (p = 0.70). Surgical site infections (SSI) were seen in 16{\%} of sarcopenic patients compared to 29{\%} without sarcopenia (p = 0.14). There was no difference in hernia recurrence between groups (p = 0.90). However, after adjusting for diabetes and BMI, a 10 cm2/m2 decrease in muscle index had 1.44 OR of postoperative complications (p < 0.05). Conclusions: Though prevalent in our population, sarcopenia was not associated with an increase in postoperative complications, surgical site occurences/infections, or hernia recurrence when previously published oncologic sarcopenia cutoffs were utilized. Previously established sarcopenia outcomes in malignancy may be attributable to an altered metabolic state that is not present in hernia repair patients. Larger-scale studies are recommended to establish new sarcopenia cutoffs for VHRs.",
keywords = "Abdominal wall reconstruction, AWR, Sarcopenia, Ventral hernia repair, VHR",
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T1 - Sarcopenia and outcomes in ventral hernia repair

T2 - a preliminary review

AU - Siegal, S. R.

AU - Guimaraes, Alexander

AU - Lasarev, M. R.

AU - Martindale, Robert

AU - Orenstein, Sean

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N2 - Purpose: Sarcopenia, or loss of muscle mass, is associated with increased morbidity and mortality in oncologic resections and several other major surgeries. Complex ventral hernia repairs (VHRs) and abdominal wall reconstruction are often performed in patients at high risk for morbidity and recurrence, though limited data exist on outcomes related to sarcopenia. We aimed to determine if sarcopenia is associated with worse outcomes in patients undergoing VHR. Methods: We reviewed patients undergoing VHRs from 2014 to 2015. Preoperative CT images were analyzed for cross-sectional muscle mass. Patients with and without sarcopenia underwent statistical analysis to evaluate differences in perioperative morbidity and hernia recurrence. Muscle indices were analyzed independently for outcomes. Results: 135 patients underwent VHR with/without fistula takedown, staged repairs or other concomitant procedures. 27% had sarcopenia (age 34–84, BMI 27–33, 62% male). Postoperative complications occurred in 43% of sarcopenic patients and 47% of non-sarcopenic patients (p = 0.70). Surgical site infections (SSI) were seen in 16% of sarcopenic patients compared to 29% without sarcopenia (p = 0.14). There was no difference in hernia recurrence between groups (p = 0.90). However, after adjusting for diabetes and BMI, a 10 cm2/m2 decrease in muscle index had 1.44 OR of postoperative complications (p < 0.05). Conclusions: Though prevalent in our population, sarcopenia was not associated with an increase in postoperative complications, surgical site occurences/infections, or hernia recurrence when previously published oncologic sarcopenia cutoffs were utilized. Previously established sarcopenia outcomes in malignancy may be attributable to an altered metabolic state that is not present in hernia repair patients. Larger-scale studies are recommended to establish new sarcopenia cutoffs for VHRs.

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KW - Abdominal wall reconstruction

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KW - Sarcopenia

KW - Ventral hernia repair

KW - VHR

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