Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair?
Alexis M Holland, W Lorenz, Sullivan A. Ayuso, M Katzen, Souma Kundu, David A Rosas, Brittany S Mead, Gregory T. Scarola, Vedra A. Augenstein, B. Todd Heniford
Abstract
BACKGROUND: Obesity is directly correlated with wound complications and recurrence after open ventral hernia repair. Preoperative weight loss (WL) mitigates these risks, improves overall health, and reduces intra-abdominal volume. For patients successful in losing weight, it is unclear whether this WL is maintained. STUDY DESIGN: A prospective, single-institution hernia database was queried for patients with a BMI 25 kg/m 2 or higher who were requested to lose weight and lost a minimum of 10 lbs preoperatively. Patients' weight was examined at 2 timepoints: postoperative appointment 6 months to 1 year and their most recent documented weight. RESULTS: Of 256 included patients, the average age was 58.2 ± 11.2 years, 30.5% of patients were diabetic, and 67.9% of patients were American Society of Anesthesiologists class III or IV. At initial consultation, the average BMI was 38.2 ± 6.6 kg/m 2 and 34.0 ± 5.8 kg/m 2 at the time of surgery. Average preoperative WL was 26.1 ± 17.1 lbs (10 to 120 lbs) over 10.0 ± 13.6 months.At the first postoperative timepoint, the average BMI was 33.6 ± 5.8 kg/m 2 , and patients lost an additional 1.8 ± 16.2 lbs over 8.4 ± 9.0 months after surgery. At 42.0 ± 36.2 months postoperatively, patients gained an average weight of 2.0 ± 27.1 lbs, for a net WL of 24.0 ± 31.9 lbs from consultation. After surgery, 47.3% of patients continued WL for an additional 18.6 ± 26.4 lbs (total net WL: 44.7 lbs) and decreased BMI by 2.5 ± 3.6 kg/m 2 , 0.8% maintained their same weight, and 22.3% gained back less than half of preoperative WL, totaling 70.3% of patients with long-term optimization. CONCLUSIONS: Prehabilitation-induced WL averaged 26 lbs. With 3.5 years of follow-up, patients weighed an average of 24 lbs less than their initial consult weight. Nearly half of patients continued WL postoperatively, and >70% maintained at least half of their WL, demonstrating longevity to preoperative optimization.