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Three-dimensional hernia analysis: the impact of size on surgical outcomes

机译：三维疝气分析：规模对外科结果的影响

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Introduction BMI and hernia defect size are strongly associated with outcomes after open ventral hernia repair (OVHR). The impact of abdominal subcutaneous fat (SQV), intra-abdominal volume (IAV), hernia volume (HV), and ratio of HV to intra-abdominal volume (HV:IAV, representing visceral eventration) is less clearly elucidated. This study examines the interaction of multiple markers of adiposity and hernia size in OVHR. Methods OVHR with preoperative CT scans were identified. 3D volumetric software measured HV, SQV, IAV, and HV:IAV was calculated. A principal component analysis was performed to create new component variables for collinear variables. Hernia PC was composed primarily of hernia dimensions, EAV (extra-abdominal volume PC) included SQV and BMI, and IAV PC included IAV. Results A total of 1178 OVHR patients had a preoperative CT scan. Their demographics included a mean age of 58.5 +/- 12.4 years, BMI of 34.2 +/- 7.7 kg/m(2), and 57.8% were female. The mean defect area was 150.8 +/- 136.7 cm(2), and 66.0% were recurrent, Patients had mean SQV of 6719.4 +/- 3563.9 cm(3), HV of 966.9 +/- 1303.5 cm(3), IAV of 4250.2 +/- 2118.1 cm(3), and a HV:IAV of 0.29 +/- 0.46. In multivariate analysis, Hernia PC was associated with panniculectomy (OR 1.52, CI 1.37-1.69) and component separation (OR 1.34, CI 1.21-1.49) and was negatively associated with fascial closure (OR 0.78, CI 0.69-0.88). Hernia PC was also associated with reoperation, readmission, and development of wound complications (OR 1.18, CI 1.08-1.30; OR 1.15, CI 1.04-1.27; OR 1.28, CI 1.16-1.41, respectively). EAV PC was associated with performance of a panniculectomy (OR 1.33, CI 1.20-1.48), readmission (OR 1.18, CI 1.06-1.32), and wound complications (OR 1.41, CI 1.27-1.57). IAV PC was not associated with adverse outcomes. Conclusion Values of hernia area, volume, IAV, HV:IAV, BMI, and SQV are collinear markers of patient obesity and hernia proportions. They are distinct enough to be represented by three principal component variables, indicating more nuanced discrete influences on variability of surgical outcomes other than BMI.
机译：引言BMI和Hernia缺陷尺寸与开放腹侧疝修复后的结果强烈关联（OVHR）。腹部皮下脂肪（SQV），腹内体积（IAV），疝气量（HV）和HV与腹内体积（HV：IAV）的比例的影响较小明显阐明。本研究检测肥胖和疝气大小在OVHR中的多种标志物的相互作用。方法鉴定了具有术前CT扫描的OVHR。 3D体积软件测量的HV，SQV，IAV和HV：计算IAV。执行主成分分析以为共线变量创建新的组件变量。 Hernia PC主要由Hernia尺寸组成，EAV（腹部容量PC）包括SQV和BMI，而IAV PC包括IAV。结果共1178例OVHR患者进行了术前CT扫描。他们的人口统计数据包括平均年龄为58.5 +/- 12.4岁，BMI为34.2 +/- 7.7千克/米（2）和57.8％是女性。平均缺陷面积为150.8 +/- 136.7厘米（2），66.0％复发，患者的平均SQV为6719.4 +/- 3563.9厘米（3），HV为966.9 +/-1303.5厘米（3），IAV 4250.2 +/- 2118.1厘米（3）和HV：IAV为0.29 +/- 0.46。在多变量分析中，Hernia PC与Panniculectomy（或1.52，CI 1.37-1.69）和组分分离（或1.34，CI 1.21-1.49）相关，并且与鉴定闭合（或0.78，CI 0.69-0.88）负相关。 Hernia PC还与Reoperation，阅览和开发有关的伤口并发症（或1.18，CI 1.08-1.30;或1.15，CI 1.04-1.27;或1.28，CI 1.16-1.41）。 EAV PC与Panniculectomy的性能（或1.33，CI 1.20-1.48），阅览室（或1.18，CI 1.06-1.32）和伤口并发症（或1.41，CI 1.27-1.57）。 IAV PC与不利结果无关。结论疝气区域，体积，IAV，HV：IAV，BMI和SQV的价值是患者肥胖和疝气比例的共线标记。它们明显足以由三个主成分变量表示，表明比BMI以外的外科结果变异性更为细微的离散影响。

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