Are morbid obese (class–III) patients at high risk for postoperative complications after robotic ventral hernia repair? A propensity score matching analysis

INTRODUCTION: Extreme obesity is an independent risk factor for many perioperative complications, as well as the development of ventral hernias. Many surgeons consider extreme obesity as a prohibitive factor for minimally invasive ventral hernia repair (VHR). To investigate whether robotic VHR (RVHR) has value in these high–risk patients, in this study, we aim to compare outcomes between class–III obese (BMI ≥40 kg/m2) patients and non–obese (BMI <30 kg/m2) patients.
METHODS: A retrospective analysis of a database collected between 2012 and 2020 was performed. A 1: 2 propensity score match (PSM) analysis was implemented to obtain two balanced patient groups. Univariate analyses, in unmatched and matched samples, were performed between the two groups concerning preoperative, intraoperative, and postoperative variables. Postoperative complications and morbidity (up to 90–days) were assessed using the Clavien–Dindo classification and comprehensive complication index (CCI®) score system.
RESULTS: Our initial cohort consisted of 598 patients, in which 287 unmatched patients were included. After 1: 2 PSM, 86 and 43 patients were assigned to the non–obese and class–III obese groups, respectively. Differences in unmatched patient demographics, hernia characteristics, and intraoperative variables between the two groups were resolved after matching. In an unmatched comparison, class–III obese patients experienced higher rates of Clavien–Dindo grade–II complications and cellulitis. However, the two matched groups experienced similar postoperative complication rates.
DISCUSSION AND CONCLUSION: This study revealed that class–III obese patients can obtain similar benefits from RVHR as their non–obese counterparts. Surgeons should consider patient and hernia characteristics when planning to perform RVHR in these patients, rather than BMI alone.