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Background: Damage-control surgery for trauma and intra-abdominal catastrophe is associated with a high rate of morbidities and postoperative complications. This study aimed to compare the outcomes of patients undergoing early complex abdominal wall reconstruction (e-CAWR) in acute settings versus those undergoing delayed complex abdominal wall reconstruction (d-CAWR)., Method: This study was a pooled analysis derived from the retrospective and prospective database between the years 2013 and 2019. The outcomes were compared for differences in demographics, presentation, intraoperative variables, Ventral Hernia Working Grade (VHWG), US Centers for Disease Control and Prevention wound class, American Society of Anesthesiologists (ASA) scores, postoperative complications, hospital length of stay, and readmission rates. We performed Student's t test, χ2 test, and Fisher's exact test to compare variables of interest. Multivariable linear regression model was built to evaluate the association of hospital length of stay and all other variables including the timing of complex abdominal wall reconstruction (CAWR). A p value of <0.05 was considered significant., Results: Of the 236 patients who underwent CAWR with biological mesh, 79 (33.5%) had e-CAWR. There were 45 males (57%) and 34 females (43%) in the e-CAWR group. The ASA scores of IV and V, and VHWG grades III and IV were significantly more frequent in the e-CAWR group compared with the d-CAWR one. Postoperatively, the incidence of surgical site occurrence, Clavien-Dindo complications, comprehensive complication index, unplanned reoperations, and mortality were similar between the two groups. Backward linear regression model showed that the timing of CAWR (β = -11.29, p < 0.0001), ASA (β = 3.98, p = 0.006), VHWG classification (β = 3.62, p = 0.015), drug abuse (β = 13.47, p = 0.009), and two comorbidities of cirrhosis (β = 12.34, p = 0.001) and malignancy (β = 7.91, p = 0.008) were the significant predictors of the hospital length of stay left in the model., Conclusion: Early CAWR led to shorter hospital length of stay compared with d-CAWR in multivariable regression model., Level of Evidence: Therapeutic, level IV., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Hospital readmissions are recognized as indicators of poor healthcare services which further increase patient morbidity. The aim of this study is to analyze predicting factors for the 30-day and 90-day readmissions after a complex abdominal wall reconstruction (CAWR)., Methods: A pooled analysis of the prospective study and retrospective database patients undergoing CAWR with acellular porcine dermis from 2012 to 2019 was carried out. Independent t test for continuous variables and Chi-square and Fischer's exact tests for categorical variables were used. A multivariable logistic regression model and linear regression analysis were used to analyze the independent predictors of 30-day and 90-day readmissions., Results: A total of 232 patients underwent CAWR, and the readmission rate (RR) was 16.8% (n = 40). The 30-day and 90-day RR was 11.3% (n = 23) and 13.3% (n = 33), respectively. There were no statistical differences in age, frailty, and gender distribution between the two groups. There was no difference in ASA score, type of component separation, ventral hernia working group class, size of the biological mesh, placement of mesh, and intestinal resection rate. The Clavien-Dindo complications and mean comprehensive complication index (CCI) were higher in the readmission group as compared to no readmission group (p < 0.01). Readmitted patients had higher surgical site infections (p < 0.01) and wound necrosis (p = 0.01). Higher CCI, past or concomitant pelvic surgery, and the presence of enterocutaneous fistula were independent predictors of earlier days to readmission., Conclusion: Surgical site occurrences were associated with 30-day and 90-day readmissions after CAWR, while the presence of ascites and dialysis was associated with 90-day readmissions.

Background: The aim of this systematic review and meta-analysis was to evaluate whether computed tomography (CT) scan adds any diagnostic value in the evaluation of stab wounds of the anterior abdominal wall as compared with serial clinical examination (SCE)., Methods: PubMed, EMBASE, Cochrane Library, and MEDLINE via Ovid were systematically searched for records published from 1980 to 2018 by two independent researchers (M.G., R.L.). Quality assessment, data extraction, and analysis were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Mantel-Haenszel method with odds ratio (OR) and 95% confidence interval (95% CI) as the measure of effect size was used for meta-analysis., Results: Three studies (1 randomized controlled trial and 2 observational studies) totaling 319 patients were included in the meta-analysis. Overall laparotomy rate was 12.8% (22 of 172 patients) in SCE versus 19% (28 of 147 patients) in CT. This difference was not significant (OR [95% CI], 0.63 [0.34-1.16]; p = 0.14). Negative laparotomy rate was 3.5% (6 of 172 patients) in SCE versus 5.4% (8 of 147 patients) in CT. The difference was not significant (OR [95% CI], 0.61 [0.20-1.83]; p = 0.37)., Conclusion: This meta-analysis compared SCE with CT scan in patients presenting with stab wounds of the anterior abdominal wall and provided level II evidence showing no additional benefit in CT scan. Further observational and experimental clinical studies are needed to confirm the findings of this meta-analysis., Level of Evidence: Systematic review and meta-analysis, level II.

Background: Perioperative outcomes in patients who undergo complex abdominal wall reconstruction (CAWR) may be associated with severe complications, mainly when these procedures are done urgently or emergently. This study aims to identify perioperative predictors of outcomes after CAWR with biologic mesh (BM)., Materials and Methods: In a retrospective study, perioperative complications (length of hospital stay, ventilator support, surgical site infection, need for wound VAC, reoperation, total complications, and mortality), were analyzed in all patients who underwent open CAWR with BM over six years in two academic centers. Furthermore, we examined the effect of cardiac disease, BMI, diabetes, COPD, case mixed index, hernia size, wound classification, mesh technique, the setting of surgery, on perioperative complications. Multivariable linear and logistic regression analyses were performed., Results: There were 220 patients: 134 patients from center A and 86 patients from center W Mean age was 54.9 ± 14.8 years, 47.7% were females, 33.8% of the patients had BMI ≥30 kg/m2 and median hospital length of stay was 7 days. Center W patients had increased need for mechanical ventilation (10.5% vs. 3%, p = 0.02) and higher need for wound VAC (19.8% vs. 6.7%, p = 0.003). On multivariable linear regression, independent patient predictors of increased hospital length of stay (HLO) were: urgent/emergent surgery (β 6.93, 95% CI 1.65-12.22, p = 0.01), cardiac disease (β 7.84, 95% CI 1.23-14.46, p = 0.02) and epigastric defect (β 13.68, 95% CI 0.29-27.06, p = 0.045). Addition-ally, urgent/emergent setting (OR 3.06, 95% CI 1.69-5.55, p < 0.001) and cardiac disease (OR 2.15, 95% CI 1.03-4.50, p = 0.042) were independently associated with increased odds for perioperative complications., Conclusions: Perioperative complications of patients undergoing CAWR are considerable and depend on defect complexities, the setting of surgery, comorbidities, wound classification, procedural factors, and case-mix index. Prospective studies on perioperative complications are needed., Competing Interests: Declaration of competing interest None., (Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)