Modifying Risks in Ventral Hernia Patients With Prehabilitation: A Randomized Controlled Trial. Issue 4 (October 2018)

• Record Type: Journal Article
• Authors: Liang, Mike K.; Bernardi, Karla; Holihan, Julie L.; Cherla, Deepa V.; Escamilla, Richard; Lew, Debbie F.; Berger, David H.; Ko, Tien C.; Kao, Lillian S.
• Is Part Of: Annals of surgery. Volume 268:Issue 4(2018:Oct.)
• Publication Date: 2018-10
• Subjects: abdominal hernia -- exercise -- optimization -- prehabilitation -- preoperative training -- umbilical hernia -- ventral hernia -- weight loss; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002961
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study was to determine whether preoperative nutritional counseling and exercise (prehabilitation) in obese patients with ventral hernia repair (VHR) results in more hernia-free and complication-free patients. Background: Obesity and poor fitness are associated with complications following VHR. These issues are prevalent in low socioeconomic status patients. Methods: This was a blinded, randomized controlled trial at a safety-net academic institution. Obese patients (BMI 30 to 40) seeking VHR were randomized to prehabilitation versus standard counseling. VHR was performed once preoperative requirements were met: 7% total body weight loss or 6 months of counseling and no weight gain. Primary outcome was the proportion of hernia-free and complication-free patients. Secondary outcomes were wound complications at 1 month postoperative and weight loss measures. Univariate analysis was performed. Results: Among 118 randomized patients, prehabilitation was associated with a higher percentage of patients who lost weight and achieved weight loss goals; however, prehabilitation was also associated with a higher dropout rate and need for emergent repair. VHR was performed in 44 prehabilitation and 34 standard counseling patients. There was a trend toward less wound complication in prehabilitation patients (6.8% vs 17.6%, P = 0.167). The prehabilitation group was more likely to be hernia-free and complication-free (69.5% vs 47.5%, P = 0.015). Conclusions: It is feasible to implement a prehabilitation program for obese patients at a safety-net hospital. Prehabilitation patients have a higher likelihood of being hernia-free and complication-free postoperatively. Although further trials and long-term outcomes are needed, prehabilitation may benefit obese surgical patients, but there may be increased risks of dropout and emergent repair. Clinical Trial Registration: This trial was registered with clinicaltrials.gov (NCT02365194) Abstract : Supplemental Digital Content is available in the text