Outcomes of component separation for ventral hernia repair in an emergent setting: Analysis of the American College of Surgeons (ACS) NSQIP

INTRODUCTION: Large ventral hernias are encountered in the emergent setting, and the best management strategy is unclear. Component separation (CS) is a technique that can be used for repair of large ventral hernias. We sought to investigate and compare outcomes of elective CS with emergent CS using a large national database. METHODS: All patients undergoing elective and emergent ventral hernia repair with CS between 2005 and 2014 were identified utilizing the ACS NSQIP database. CPT codes used to identify ventral hernia repair were 49565 and 49560 and 15734 for CS. RESULTS: In the study period, 6, 286 patients underwent non-emergent ventral hernia repair with CS and 74 patients underwent emergent ventral hernia repair. Demographics were similar overall with the exception of wound class. As expected, emergent CS had higher wound class (clean/contaminated and higher). There were no differences in superficial incisional surgical site infection (SSI) (7.0% vs 5.4%, p = 0.760), organ/space SSI (3.0% vs 5.4%, p = 0.387), or perioperative blood transfusions (5.8% vs 12.2%, p = 0.068). Stratified by wound class, there were no differences in superficial incisional SSI, organ space SSI, or wound disruption between emergent and elective CS. CONCLUSIONS: While rarely performed emergently, immediate postoperative wound complications for emergency CS appear similar to those with elective CS. A 1-stage abdominal wall reconstruction in the emergent setting may represent a viable option for large or complex ventral hernia repair in select patients