American Surgical Association Annual Meeting
Search Meeting Site Only
 
Main ASA Website
Current Meeting Home
Final Program
Past & Future Meetings

 

 

Back to 2016 Annual Meeting


Is Non-Operative Management Warranted in Comorbid Patients with Ventral Hernias?: A Prospective, Patient-Centered Study
Julie L Holihan*, Blake E Henchcliffe*, Jiandi Mo*, Juan R Flores-Gonzalez*, Tien C Ko*, Lillian S Kao, Mike K Liang*
University of Texas Health Science Center at Houston, Houston, TX

Objectives
Non-operative management of ventral hernias (VHs) is often recommended for patients at increased risk of complications; however, the impact of this management strategy on outcome and quality of life (QoL) is unknown. We hypothesize that QoL is better among patients with VHs managed operatively.
Methods
Patients with a VH from a single-center hernia clinic were prospectively enrolled between 6/2014 and 6/2015. Non-operative management was recommended if smoking, body mass index >33 kg/m2, or poorly-controlled diabetes were present. Outcomes included surgical site infection (SSI), recurrence, and QoL measured using a validated, hernia-specific survey (modified Activities Assessment Scale) prior to surgeon consultation and at 6-months. Risk-adjusted outcomes between non-operative and operative groups were compared using: (1) paired t-test on a propensity score-matched subset and (2) multivariable analysis on the overall cohort.
Results
152 patients (non-operative=97; operative=55) were enrolled. In the propensity-matched cohort (n=90), both groups had similar baseline QoL scores, but only repaired patients had improved scores on 6-month follow-up (Table). In the overall cohort, non-operative management was strongly associated with lower QoL scores (log odds ratio=-26.5; 95%CI=-35.0 to -18.0).
Conclusions
This is the first prospective study comparing management strategies in comorbid VH patients. Elective repair improves hernia-related QoL in low to moderate risk patients. Trade-offs of a conservative operative strategy need to be reevaluated in terms of estimating risk and incorporating patient-centered outcomes.
Table: Matched Cohort*
Total (n=90)Surgery (n=45)Non-op (n=45)p-value
Age50.4±11.348.9±12.251.9±10.30.20
Gender (male)49 (54.4%)23 (51.1%)26 (57.8%)0.67
BMI31.6±5.831.0±5.232.1±6.30.39
Smoker13 (14.4%)7 (15.6%)6 (13.3%)<0.01
ASA Score
111 (12.2%)5 (11.1%)6 (13.3%)0.52
251 (56.7%)26 (57.8%)25 (55.6%)
326 (28.9%)14 (31.1%)12 (26.7%)
42 (2.2%)02 (4.4%)
Diabetes20 (22.2%)10 (22.2%)10 (22.2%)>0.99
Area (cm2)43.5±91.652.9±114.333.8±60.10.33
Hernia type
Primary26 (28.9%)16 (35.6%)10 (22.2%)0.24
Incisional64 (71.1%)29 (64.4%)35 (77.8%)
Ventral Hernia Working Group Grade
I15690.35
II643133
III1073
IV110
SSI-2 (4.4%)--
Recurrence-1 (2.2%)--
Baseline QoL**35.1±24.334.7±24.035.6±24.90.86
Follow-up QoL**46.8±11.356.9±12.236.6±10.3<0.01
* Cohorts matched on baseline pain scores, body mass index (BMI), smoking, prior ventral hernia repair, diabetes mellitus, and hernia size
** Based on the modified Activities Assessment Scale which is a validated, hernia-specific quality of life survey scored on 1-100 normalized points where 1=poor quality of life and 100=perfect quality of life


Back to 2016 Annual Meeting


© 2022 American Surgical Association. All Rights Reserved. Privacy Policy.