Data suggest BMI cutoffs for hernia surgery could be unnecessary

Editor's Note

The impact of body mass index (BMI) on hernia recurrence is likely overstated, and symptomatic patients should not be denied abdominal wall reconstruction procedures due to an arbitrary BMI cutoff of 35 kg/m2. This is the conclusion of a study published February 1 in the journal Surgery by researchers who sought to determine whether obesity, which is linked to short-term wound morbidity, also had sufficient effect on long-term outcomes to justify a BMI cutoff.

To that end, the identified 1,089 patients undergoing open, clean transversus abdominis release from August 2014 to January 2022 at the Cleveland Clinic Center for Abdominal Core Health who had completed 1-year follow up. “Morbid obesity is associated with 90-day wound morbidity; however, short-term complications did not translate to higher reoperation or long-term recurrence rates,” they wrote.

Highlights of the data include:

• Higher BMI was associated with surgical site infection and occurrence but not surgical site occurrence requiring procedural intervention.
• Hernia width was associated with both surgical site occurrence and surgical site occurrence requiring procedural intervention.
• Hernia recurrence rate at 1 year was lower for the body mass index ≥35 kg/m2 group.
• Hernia width was associated with recurrence; BMI was not.
• Both groups experienced significant improvement in hernia-specific quality of life at 1 year.