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OPTIMAL TIMING FOR ELECTIVE VENTRAL HERNIA REPAIR TO PREVENT BOWEL OBSTRUCTION UTILIZING A POPULATION-LEVEL MODEL
Sourav Podder
*, Subhadra Acharya, Julia Baran, Scott Koeneman, Christopher Keating, Francesco Palazzo, Sami Tannouri
Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Ventral hernia repairs (VHR) are among the most commonly performed surgical procedures worldwide, however optimal timing of repair remains a topic of significant debate. The presence of ventral hernia is a risk factor for intestinal obstruction, along with the possibility of serious complications. Recent evidence has advocated for delaying repair of some ventral hernias to optimize a patient’s modifiable risk factors, such as weight, smoking status, diabetes, and cardiopulmonary diseases. Our study aims to utilize population-level data to model ideal timing of ventral hernia repair after diagnosis in order to minimize the occurrence of bowel obstruction in those patients awaiting repair.
Methods: This retrospective study utilized the TriNetX Research Network, a large global health research network that provides access to aggregated electronic medical records from multiple healthcare organizations. Using ICD-9, ICD-10, ICD-PCS, and CPT codes, we identified our patient cohort, relevant demographics and health history covariates. Using ventral hernia diagnosis as the index event, we built a Cox proportional hazards regression model, with surgery status as a time-varying covariate, to assess the impact of surgery on incidence of obstruction. To demonstrate our findings, we examined a representative standard case, a 50-year-old white male, reflective of the average patient in the cohort, and assessed their predicted likelihood of freedom from bowel obstruction over time. Using our Cox model, we simulated this patient undergoing surgery within 14 days, 90 days, 1 year, 5 years, 10 years, and never.
Results: We identified 587,384 patients with ventral hernia diagnosis. These patients had a median age of 50 years; 51% were men; 64.3% were white. We simulated an average patient undergoing surgery at several time points (Figure). Our model estimates that early repair within 14 days of diagnosis is beneficial for freedom from bowel obstruction. Earlier intervention provides even greater advantages by minimizing the risk of obstruction over time.
Conclusion: Our study demonstrates that an average patient diagnosed with ventral hernia will benefit from the earliest possible surgical intervention to maximally reduce the risk bowel obstruction over time. While delaying repair may allow for the optimization of patient comorbidities, it also increases the risk of complications such as bowel obstruction. Therefore, a balanced approach between optimization and a timely repair should be strongly considered. Next steps involve analyzing additional hernia specific outcomes to refine timing recommendations and ensure optimal decision-making.
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