Components Separation for Abdominal Wall Reconstruction: Outcomes and Risk Factors - A Review of 605 Single Institution Cases
Sanjay Naran, MD, Sameer Shakir, BS, Patrick Emelife, MD, Meghan Quigley, MD, James Russavage, DMD, MD, Ernest Manders, MD, J Peter Rubin, MD, Carolyn De La Cruz, MD, Michael Gimbel, MD, Vu Nguyen, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
PURPOSE: We critically analyze our experience with abdominal wall component separation, and identify prognosticators that affect complications and long-term clinical outcomes.
METHODS: We retrospectively reviewed all patients who underwent components separation between 2000-2010. Over 40 data points were collected for each patient, documenting major and minor complications, acute and chronic.
RESULTS: Our cohort consists of 605 patients. Mean age was 53.6±13.45 years, BMI 32.7±7.8 kg/m2, and defect size 202.9±228.7 cm2. Average defect width was 12±2 cm. Recurrence rate was 20.0%. Post-operative complications included heamatoma (3.8%), seroma (6.4%), ischemia (3.0%), infection (13.3%), superficial wound breakdown (5.5%), and DVT/PE (3.0%). Respiratory co-morbidities (p=0.001) were associated with an increased risk of recurrence (OR=2.49). Prior use of a prosthetic (p=0.001, OR=2.01), and use of a prosthetic at the time of separation (p=0.048, OR=1.73), were significant predictors of recurrence. The occurrence of any post-operative complication (p<0.001) significantly increased the likelihood of eventual recurrence. We found no association between recurrence and BMI. Males (p=0.005), high BMI patients (p=0.015) and large defect area patients (p=0.022) were more likely to experience any complication.
CONCLUSIONS: We identify various risk factors that are statistically significant in their association with particular complications. Patients with respiratory co-morbidities, prior use of a prosthetic, and use of a prosthetic at the time of separation, are significantly more likely to have a recurrence; however, in our cohort the components separation technique remains a reliable method of abdominal wall reconstruction even in the setting of co-morbidities thought to be associated with recurrence.
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