Is non-operative management warranted in ventral hernia patients with comorbidities? A case-matched, prospective 3 year follow-up, patient-centered study

Karla Bernardi, Alexander C Martin, Julie L Holihan, Oscar A Olavarria, Juan R Flores-Gonzalez, Deepa V Cherla, Nicole B Lyons, Puja Shah, Lillian S Kao, Tien C Ko, Mike K Liang
American Journal of Surgery 2019, 218 (6): 1234-1238

BACKGROUND: We hypothesized that long-term quality of life (QoL) is improved among patients with ventral hernias (VHs) and comorbid conditions managed operatively than with non-operative management.

METHODS: This was the 3-year follow-up to a prospective observational study of patients with comorbid conditions and VHs. Primary outcome was change in QoL measured utilizing the modified Activities Assessment Scale (AAS), a validated, hernia-specific survey. Outcomes were compared using: (1)paired t-test on matched subset and (2)multivariable linear regression on the overall cohort.

RESULTS: In the matched cohort (n = 80; 40/group), the operative group experienced a significantly greater improvement in QoL compared to the non-operative group (28.4 ± 27.1 vs. 11.8 ± 23.8,p = 0.005). The operative group, had 10 (25.0%) reported recurrences while the non-operative group, reported 4/15 (26.7%) recurrences among the 15 (37.5%) patients that underwent repair. On multivariable analysis of the whole cohort (n = 137), operative management was associated with a 19.5 (95% CI7.0-31.9) point greater improvement in QoL compared to non-operative management.

CONCLUSIONS: This is the first long term prospective study showing the benefits of operative as opposed to non-operative management of patients with comorbid conditions and VHs.

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