Abdominal wall reconstruction with component separation at the time of incisional hernia among survivors of emergency laparotomy after traumatic injuries: a population-based analysis of complications and healthcare utilization

Abstract

Aim: The utilization and outcomes of abdominal wall reconstruction (AWR) using advanced techniques such as component separation for incisional hernia (IH) repair following laparotomy in trauma populations has not been described. The objective was to describe AWR with component separation (AWR-CS) utilization in this setting and to assess postoperative complications and readmissions.

Methods: We identified adult patients admitted for IH repair (IHR) with a history of and admission for traumatic injuries with concurrent laparotomy in six geographically diverse statewide inpatient databases (2006-2015). AWR-CS was defined by ICD-9 codes corresponding to myocutaneous flap. Risk-adjusted logistic regression and generalized linear models were used to compare postoperative complications, 30-day readmissions and cumulative costs associated with AWR-CS.

Results: Of 952 patients with a history of trauma laparotomy who were admitted electively for IHR, 6.8% underwent AWR-CS. Patients who underwent AWR-CS experienced increased complications [adjusted odds ratio 2.6 (95%CI: 1.48-4.57); P < 0.001], cumulative costs (median $ 20,805 vs. $ 15,529; P < 0.001) and longer length-of-stay (median days 6 vs. 5; P = 0.002). These differences were driven by postoperative complication, which were independently associated with increased length of stay [predicted mean difference 6.53 days (95%CI: 4.66-8.41); P < 0.001], costs [$ 14,550 (95%CI: $ 9,258-19,841); P < 0.001] and 30-day cumulative costs [$ 20,176 (95%CI: $ 12,621-27,731); P < 0.001] within risk-adjusted analyses.

Conclusion: AWR-CS is part of the armamentarium needed to manage trauma laparotomy survivors who develop complex IH defects requiring surgical repair. It can result in increased complications that amplify postoperative healthcare utilization. Leverage of tools for the identification of high-risk patients, prehabilitation and enhanced surgical techniques is warranted to minimize postoperative complications in these patients.

Keywords

Flap / incisional hernia / trauma / laparotomy / complication / readmission / epidemiology / abdominal wall reconstruction

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