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The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience

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Abstract

Introduction

Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR).

Methods

We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: “Optimal GC” (HbA1c < 7%), “Sub-optimal GC” (HbA1c 7-8.4%), and “Poor GC” (HbA1c ≥ 8.5%) and their outcomes were compared.

Results

514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented.

Conclusion

In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.

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Data Availability

The data used in this study are available upon reasonable request to the corresponding author (Nir Messer). Requests will be considered on a case-by-case basis and may be subject to specific conditions.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. As this study involved the use of existing data and did not involve direct interaction with human subjects, no patients were enrolled, and therefore, no informed consent was required. The data used in this research were anonymized and de-identified, ensuring the privacy and confidentiality of individuals in accordance with the Institutional Review Board. The research was conducted in accordance with the ethical principles outlined in the Institutional Review Board. The use of data and materials was carried out with proper authorization and in compliance with all applicable laws and regulations.

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Authors and Affiliations

  1. Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Nir Messer, Benjamin T. Miller, Lucas R.A. Beffa, Clayton C. Petro, David M. Krpata, Serrgio Mazzola Poli de Figueiredo, Aldo Fafaj, Ryan C. Ellis, Sara M. Maskal, Ajita S. Prabhu & Michael J. Rosen

  2. Department of Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel -Aviv University, Tel Aviv, Israel

    Nir Messer

  3. The Abdominal Core Health Quality Collaborative, Centennial, USA

    Li-Ching Huang

  4. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Li-Ching Huang

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  1. Nir Messer
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Contributions

All the authors contributed to the study’s conception and design. Material preparation and data collection were performed by NM. The manuscript was written by NM and MJR. All the authors commented on and revised the manuscript. All the authors read and approved the final manuscript. The study was supervised by MJR.

Corresponding author

Correspondence to Nir Messer.

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Conflict of interest

I declare that there are no conflicts of interest related to this manuscript. The study was conducted impartially, and the findings presented in the manuscript are based solely on the analysis and interpretation of the data. M.J.R receives salary support for his position in the leadership of the Abdominal Core Health Quality Collaborative (ACHQC), which is the data source for the present submission, and he receives board member support and stock options from Ariste Medical. He also has a research grant paid to his institution by Tela Bio for a clinical trial. A.S.P. has received funding paid to her institution from Intuitive Surgical Inc. and personal fees from Medtronic, Intuitive Surgical, CMR Surgical, and Verb Surgical. L.R.B has received an honorarium from Intuitive.

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Messer, N., Miller, B.T., Beffa, L.R. et al. The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience. Hernia 28, 2291–2300 (2024). https://doi.org/10.1007/s10029-024-03161-2

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