Does BMI Impact Outcomes in Patients Undergoing Open Abdominal Wall Reconstruction? A Systematic Review and Meta‐Analysis
Bibliographic record
Abstract
ABSTRACT Importance Obesity is a significant factor that increases complication rates in patients undergoing abdominal wall reconstruction (AWR). This has led to caution about performing elective AWR in patients with higher body mass index (BMI). In light of this, our study aims to synthesize the current information on AWR outcomes in patients stratified according to the obesity classification, providing evidence‐based insights into the impact of BMI on AWR outcomes. Objective To compare the clinical outcomes in patients of different BMI groups undergoing AWR. Data Sources A systematic literature search of two databases (PubMed and Cochrane CENTRAL) from January 1st, 1966, until July 31, 2024, identified five relevant studies. Study Selection Included in our analysis were original studies that assessed clinical outcomes in patients with a BMI < 35 kg/m 2 compared to those with a BMI ≥ 35 kg/m 2 undergoing elective AWR. Studies with a patient population of less than 18 years or oncologic patient population were excluded. Data Extraction and Synthesis This systematic review and meta‐analysis are reported as per the PRISMA statement. As recommended by the Cochrane Collaboration, the Newcastle–Ottawa scale was used to evaluate methodological quality. The Mantel–Haenszel random‐effects method was used to calculate the pooled odds ratios (ORs) with their 95% confidence intervals (CIs). Main Outcome The primary outcomes were hernia recurrence, readmission, reoperation, and surgical site infection (SSI). Results Out of 4769 classifiable patients that underwent AWR, the majority were obese‐ CDC Class 1, 2 (2401; 50%) or morbidly obese‐Class 3 (1054; 22%). Patients with a BMI < 35 kg/m 2 compared to a BMI ≥ 35 kg/m 2 were associated with significantly decreased odds of readmission (OR 0.52, 95% CI 0.38–0.70, I 2 = 0%, and p < 0.0001), reoperation (OR 0.72, 95% CI 0.55–0.93, I 2 = 17%, and p = 0.01), and developing SSI (OR 0.62, 95% CI 0.48–0.81, I 2 = 35%, and p = 0.0005), whereas hernia recurrence (OR 1.03, 95% CI 0.35–3.00, I 2 = 88%, and p = 0.96) was statistically insignificant. Conclusion and Relevance A patient's BMI should not be the sole determinant when planning elective AWR, as increasing BMI does not impact hernia recurrence rates. However, obese patients should be counseled on the higher risk of developing infections, requiring reoperation, and necessitating readmission due to their weight.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.040 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.041 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".