Risk Factors for Surgical Site Complications Following Combined General and Plastic Surgical Abdominal Wall Reconstruction

Abstract

Objective: This study aims to identify and quantify patient-specific, operative, and specialty-specific risk factors for SSOs following combined AWR.

Materials and Methods: A retrospective cohort study was conducted on 512 patients who underwent combined general and plastic surgical AWR for complex ventral hernias. Data on demographics, comorbidities, operative details, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A p-value of less than 0.05 was considered statistically significant.

Results: The overall SSO rate was 23.4% (n=120), with an SSOPI rate of 11.7% (n=60). Multivariate analysis revealed that a Body Mass Index (BMI) > 35 kg/m² (OR 2.84, p=0.002), active smoking (OR 2.15, p=0.011), preoperative HbA1c > 7.5% (OR 1.98, p=0.024), and operative time > 300 minutes (OR 2.45, p=0.008) were independent risk factors for SSOs. Furthermore, the use of anterior component separation (OR 3.12, p=0.004) and the absence of intraoperative indocyanine green (ICG) angiography for flap assessment (OR 2.67, p=0.015) significantly increased the risk of wound dehiscence.

Conclusion: Combined AWR is associated with a substantial risk of SSOs. Modifiable risk factors such as smoking, glycemic control, and intraoperative flap perfusion assessment must be rigorously optimized to mitigate complications in this high-risk population.