Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes
Background:. Concurrent panniculectomy with abdominal wall reconstruction (CP-AWR) as a single-stage operation has reported increased complications, but constant quality improvement can improve results. This study describes outcomes for 21 years, impacted by evidence-based-practice changes. Methods:...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2024-12-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006381 |
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| author | Alexis M. Holland, MD William R. Lorenz, MD Matthew N. Marturano, MD Rose K. Hollingsworth, BA Gregory T. Scarola, MS Brittany S. Mead, MD B. Todd Heniford, MD Vedra A. Augenstein, MD |
| author_facet | Alexis M. Holland, MD William R. Lorenz, MD Matthew N. Marturano, MD Rose K. Hollingsworth, BA Gregory T. Scarola, MS Brittany S. Mead, MD B. Todd Heniford, MD Vedra A. Augenstein, MD |
| author_sort | Alexis M. Holland, MD |
| collection | DOAJ |
| description | Background:. Concurrent panniculectomy with abdominal wall reconstruction (CP-AWR) as a single-stage operation has reported increased complications, but constant quality improvement can improve results. This study describes outcomes for 21 years, impacted by evidence-based-practice changes.
Methods:. Prospectively maintained database was reviewed for CP-AWR and separated by surgery date: “early” (2002–2016) and “recent” (2017–2023). A 1:1 propensity-scored matching was performed based on age, tobacco use, body mass index (BMI), American Society of Anesthesiologists (ASA) score, wound class, and defect size.
Results:. Of 701 CP-AWRs, 196 pairs matched. Match criteria were not significantly different between early and recent groups, except for BMI (34.6 ± 7.2 versus 32.1 ± 6.01 kg/m2; P = 0.001). Groups were comparable in sex and diabetes, but recent patients had fewer recurrent hernias (71.4% versus 56.1%; P = 0.002). Recent patients had more biologic (21.9% versus 49.0%; P < 0.001) and preperitoneal mesh (87.2% versus 97.4%; P = 0.005). Readmission and reoperation did not significantly differ, but length of stay (8.3 ± 6.7 versus 6.5 ± 3.4 d; P = 0.001) and wound complications decreased over time (50.5% versus 25.0%; P < 0.001). Hernia recurrence rates improved (6.6% versus 1.5%; P = 0.019), but follow-up was shorter (50.9 ± 52.8 versus 22.9 ± 22.6 months; P < 0.0001).
Conclusions:. Despite patient complexity, outcomes of CP-AWR improved with implementation of evidence-based-practice changes in preoperative optimization, intraoperative technique, and postoperative care. This large dataset demonstrates the safety of a single-stage repair that should be part of hernia surgeons' repertoire. |
| format | Article |
| id | doaj-art-17a72b9fad79449180b1450979bafa51 |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-17a72b9fad79449180b1450979bafa512025-01-24T09:19:45ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-12-011212e638110.1097/GOX.0000000000006381202412000-00062Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement OutcomesAlexis M. Holland, MD0William R. Lorenz, MD1Matthew N. Marturano, MD2Rose K. Hollingsworth, BA3Gregory T. Scarola, MS4Brittany S. Mead, MD5B. Todd Heniford, MD6Vedra A. Augenstein, MD7From the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NCFrom the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NCFrom the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NCFrom the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NCFrom the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NCFrom the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NCFrom the * Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC† Carolinas Medical Center, Charlotte, NC.Background:. Concurrent panniculectomy with abdominal wall reconstruction (CP-AWR) as a single-stage operation has reported increased complications, but constant quality improvement can improve results. This study describes outcomes for 21 years, impacted by evidence-based-practice changes. Methods:. Prospectively maintained database was reviewed for CP-AWR and separated by surgery date: “early” (2002–2016) and “recent” (2017–2023). A 1:1 propensity-scored matching was performed based on age, tobacco use, body mass index (BMI), American Society of Anesthesiologists (ASA) score, wound class, and defect size. Results:. Of 701 CP-AWRs, 196 pairs matched. Match criteria were not significantly different between early and recent groups, except for BMI (34.6 ± 7.2 versus 32.1 ± 6.01 kg/m2; P = 0.001). Groups were comparable in sex and diabetes, but recent patients had fewer recurrent hernias (71.4% versus 56.1%; P = 0.002). Recent patients had more biologic (21.9% versus 49.0%; P < 0.001) and preperitoneal mesh (87.2% versus 97.4%; P = 0.005). Readmission and reoperation did not significantly differ, but length of stay (8.3 ± 6.7 versus 6.5 ± 3.4 d; P = 0.001) and wound complications decreased over time (50.5% versus 25.0%; P < 0.001). Hernia recurrence rates improved (6.6% versus 1.5%; P = 0.019), but follow-up was shorter (50.9 ± 52.8 versus 22.9 ± 22.6 months; P < 0.0001). Conclusions:. Despite patient complexity, outcomes of CP-AWR improved with implementation of evidence-based-practice changes in preoperative optimization, intraoperative technique, and postoperative care. This large dataset demonstrates the safety of a single-stage repair that should be part of hernia surgeons' repertoire.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006381 |
| spellingShingle | Alexis M. Holland, MD William R. Lorenz, MD Matthew N. Marturano, MD Rose K. Hollingsworth, BA Gregory T. Scarola, MS Brittany S. Mead, MD B. Todd Heniford, MD Vedra A. Augenstein, MD Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes Plastic and Reconstructive Surgery, Global Open |
| title | Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes |
| title_full | Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes |
| title_fullStr | Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes |
| title_full_unstemmed | Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes |
| title_short | Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes |
| title_sort | concurrent panniculectomy with abdominal wall reconstruction a propensity scored matched study of quality improvement outcomes |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006381 |
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