Impact of body mass index on open ventral hernia repair: A retrospective review

Background. A large proportion of patients presenting for ventral hernia repair are obese. It remains unclear, however, whether the degree of obesity is an independent risk factor for adverse outcomes after ventral hernia repair. This study aims to characterize the influence of body mass index class on postoperative complications after open ventral hernia repair. Methods. A retrospective analysis was conducted using data from the database of the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015. Patients were stratified into 7 body mass index classes, as well as by type of hernia (reducible versus strangulated) and time of repair (initial versus recurrent). We determined the relationships between body mass index class and patient demographics, comorbidities, and risk of perioperative complications. Results. Our cohort consisted of 102,191 patients, 58.5% of whom were obese. When stratified by body mass index class, higher classes were associated with all postoperative complications (P < .0001) with a steady increase in complication rates with increasing body mass index class. Patients with strangulated hernias had greater complication rates than those with reducible hernias (P < .0001). Patients with recurrent hernias also had greater complication rates than those with initial hernias (P < .0001). Conclusion. Increased body mass index is a risk factor for operative, medical, and respiratory complications after open ventral hernia repair. Patients with body mass index > 40 kg/m(2) have greater than twice the risk for complications with odds ratios increasing with increasing body mass index class. Strategies to encourage weight loss may need to be considered seriously prior to open ventral hernia repair, especially for patients with body mass index > 40 kg/m(2).