Sarcopenia and outcomes in ventral hernia repair: a preliminary review

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 22; no. 4; pp. 645 - 652
• Main Authors: Siegal, S. R., Guimaraes, A. R., Lasarev, M. R., Martindale, R. G., Orenstein, S. B.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.08.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Abdominal wall; Diabetes mellitus; Fistulae; Hernia; Hernias; Malignancy; Medicine; Medicine & Public Health; Morbidity; Original Article; Sarcopenia; Statistical analysis; Surgical site infections; Sarcopenia; VHR; Ventral hernia repair; AWR; Abdominal wall reconstruction
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-018-1770-8

Purpose Sarcopenia, or loss of muscle mass, is associated with increased morbidity and mortality in oncologic resections and several other major surgeries. Complex ventral hernia repairs (VHRs) and abdominal wall reconstruction are often performed in patients at high risk for morbidity and recurrence, though limited data exist on outcomes related to sarcopenia. We aimed to determine if sarcopenia is associated with worse outcomes in patients undergoing VHR. Methods We reviewed patients undergoing VHRs from 2014 to 2015. Preoperative CT images were analyzed for cross-sectional muscle mass. Patients with and without sarcopenia underwent statistical analysis to evaluate differences in perioperative morbidity and hernia recurrence. Muscle indices were analyzed independently for outcomes. Results 135 patients underwent VHR with/without fistula takedown, staged repairs or other concomitant procedures. 27% had sarcopenia (age 34–84, BMI 27–33, 62% male). Postoperative complications occurred in 43% of sarcopenic patients and 47% of non-sarcopenic patients ( p  = 0.70). Surgical site infections (SSI) were seen in 16% of sarcopenic patients compared to 29% without sarcopenia ( p  = 0.14). There was no difference in hernia recurrence between groups ( p  = 0.90). However, after adjusting for diabetes and BMI, a 10 cm 2 /m 2 decrease in muscle index had 1.44 OR of postoperative complications ( p  < 0.05). Conclusions Though prevalent in our population, sarcopenia was not associated with an increase in postoperative complications, surgical site occurences/infections,  or hernia recurrence when previously published oncologic sarcopenia cutoffs were utilized. Previously established sarcopenia outcomes in malignancy may be attributable to an altered metabolic state that is not present in hernia repair patients. Larger-scale studies are recommended to establish new sarcopenia cutoffs for VHRs.