American Surgical Association

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Modifying Risks in Ventral Hernia Patients with Prehabilitation: A Randomized Controlled Trial (NCT02365194)
Mike K. Liang*1, Karla Bernardi*1, Julie L. Holihan*1, Deepa V. Cherla*1, Richard J. Escamilla*1, Debbie F. Lew*1, David H. Berger2, Tien C .Ko*1, Lillian S. Kao1
1University of Texas Health Science Center at Houston, Houston, TX;2Baylor College of Medicine, Houston, TX

Background:
Obesity and poor fitness are associated with complications following ventral hernia repair (VHR). These issues are prevalent in low socioeconomic status patients. We hypothesized that preoperative nutritional counseling and exercise (prehabilitation) in obese patients with VHR results in more hernia-free and complication-free patients.
Methods:
This was a blinded, randomized controlled trial at a safety-net academic institution. Obese patients (BMI 30-40) seeking VHR were randomized to prehabilitation versus standard counseling. VHR was performed once preoperative requirements were met: 7% total body weight loss or 6 months of counseling and no weight gain. Primary outcome was the proportion of hernia-free and complication-free patients. Secondary outcomes were wound complications at one month post-operative and weight loss measures. Univariate analysis was performed.
Results:
Among 113 randomized patients, prehabilitation was associated with higher percentage of patients who lost weight and achieved weight loss goals (Table). VHR was performed in 40 prehabilitation and 34 standard counseling patients. There was a trend toward less wound complication in prehabilitation patients (5% vs. 17.6%, p=0.133). The prehabilitation group was more likely to be hernia-free and complication-free (69.1% vs. 48.3%, p=0.035).
Conclusions:
It is feasible to implement a prehabilitation program for obese patients at a safety-net hospital. Prehabilitation patients have a higher likelihood of being hernia-free and complication-free post-operatively. Although further trials and long-term outcomes are needed, prehabilitation may benefit obese surgical patients.

Table
N=113Prehabilitation
(n=55)
Standard Counseling
(n=58)
P value
Initial BMI
(kg/m2)*
36.9 2.636.6 2.6
Met weight goal18.1%12.1%0.435
Lost weight 81.8%67.2%0.088
Decrease in waist size (cm)*4.6 16.71.5 8.80.016
Total weight loss (lbs)*5.5 9.33.8 9.20.331
Underwent VHR72.7%58.6%0.165
Wound Complication5%17.6%0.133
Hernia- and Complication-Free69.1%48.3%0.035
*Numbers represent mean and standard deviation


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