Preoperative Botox in Abdominal Wall Reconstruction Patients: Our Community Hospital Experience

Abstract

Introduction: Preoperative injection of Botox has been described to facilitate complex abdominal wall reconstruction (AWR). The aim of this study was to describe our community hospital outcomes after preoperative Botox. We hypothesized preoperative Botox (PB) patients would have improved fascial closure rates and a decreased rate of component separations. Methods: A retrospective review of our institution’s database was used to identify preoperative Botox AWR (PB) patients and patients who did not receive Botox (NB) from January 2014 to August 2021. A propensity score matching (PSM) was then performed between the PB and NB patients. Results: A total of 256 patients were analyzed after AWR surgery (PB: 57, NB: 199). The PB group had a lower BMI (30.2kg/m2 vs 33.0 p = 0.03) and CDC Class 3 or 4 wounds (1.8% vs 5.5% p < 0.01). However, the PB group had more panniculectomies preformed (38.6% vs 15.7% p < 0.01). After PSM, there were 41 PB and 41 NB patients. There was no difference in fascial closure rates (87.8% vs 97.6% p = 0.09). PB group however had a higher rate of component separation (53.7% vs 26.8% p = 0.01), surgical site infection (47.5% vs 14.6% p < 0.01) and 30-days adverse events (55% vs 26.8% p < 0.01). Additionally, multivariable analysis of the matched cohort also showed higher rate of surgical site infection (OR=5.69 CI=95% 1.61, 24) and 30-days adverse events (OR= 4.75 CI=95% 1.76, 17.1). Conclusion: In our study preoperative Botox injections did not reduce the rate of component separation in complex AWR patients. There was also a concomitant increase in SSI and adverse events in the pre-op Botox group.