Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair?

Abstract

Obesity is directly correlated with wound complications and recurrence after open ventral hernia repair. Preoperative weight loss (WL) mitigates these risks, improves overall health, and reduces intra-abdominal volume. For patients successful in losing weight, it is unclear whether this WL is maintained. A prospective, single-institution hernia database was queried for patients with a BMI 25 kg/m 2 or higher who were requested to lose weight and lost a minimum of 10 lbs preoperatively. Patients' weight was examined at 2 timepoints: postoperative appointment 6 months to 1 year and their most recent documented weight. Of 256 included patients, the average age was 58.2 ± 11.2 years, 30.5% of patients were diabetic, and 67.9% of patients were American Society of Anesthesiologists class III or IV. At initial consultation, the average BMI was 38.2 ± 6.6 kg/m 2 and 34.0 ± 5.8 kg/m 2 at the time of surgery. Average preoperative WL was 26.1 ± 17.1 lbs (10 to 120 lbs) over 10.0 ± 13.6 months.At the first postoperative timepoint, the average BMI was 33.6 ± 5.8 kg/m 2 , and patients lost an additional 1.8 ± 16.2 lbs over 8.4 ± 9.0 months after surgery. At 42.0 ± 36.2 months postoperatively, patients gained an average weight of 2.0 ± 27.1 lbs, for a net WL of 24.0 ± 31.9 lbs from consultation. After surgery, 47.3% of patients continued WL for an additional 18.6 ± 26.4 lbs (total net WL: 44.7 lbs) and decreased BMI by 2.5 ± 3.6 kg/m 2 , 0.8% maintained their same weight, and 22.3% gained back less than half of preoperative WL, totaling 70.3% of patients with long-term optimization. Prehabilitation-induced WL averaged 26 lbs. With 3.5 years of follow-up, patients weighed an average of 24 lbs less than their initial consult weight. Nearly half of patients continued WL postoperatively, and >70% maintained at least half of their WL, demonstrating longevity to preoperative optimization.