Long-Term Outcomes of Preoperative Botulinum Toxin Use in Abdominal Wall Reconstruction: A Propensity-Matched Analysis of More Than 5,000 Patients Over 5 Years

Abstract Background Preoperative botulinum toxin (BTX) has been proposed to facilitate myofascial medialization and tension reduction in abdominal wall reconstruction (AWR), but long-term comparative outcomes are unclear. Objectives To compare short- and long-term postoperative outcomes after AWR in patients receiving preoperative BTX versus no BTX. Methods We performed a retrospective cohort study using the TriNetX National Health Research Network. Adults undergoing AWR were identified by ICD-10/CPT codes and assigned to BTX or no-BTX cohorts. Propensity score matching (1:1) balanced demographics, comorbidities, related procedures, and medications at each follow-up point. Outcomes included hernia recurrence, infections, wound disruption, seroma, hematoma, surgical site infection (SSI), and reoperation, assessed at 6 months, 1, 3, and 5 years. Results At 6 months, BTX was associated with lower hernia recurrence (32.1% vs 35.6%; p=0.013) but higher risks of infections (14.4% vs 10.5%; p<0.001), wound disruption (8.7% vs 4.7%; p<0.001), hematoma (1.3% vs 0.5%; p=0.003), SSI (3.9% vs 2.4%; p=0.002), and reoperation (10.7% vs 7.8%; p=0.001). From 1 to 5 years, recurrence rates no longer differed significantly between groups (e.g., 5 years: 42.6% vs 44.8%; p=0.112). The BTX cohort continued to demonstrate higher rates of infections, wound disruption, hematoma, SSI, and reoperation across later time points (all p<0.05). Conclusions Preoperative BTX for AWR was linked to an early reduction in recurrence but higher postoperative complications and reoperation over time. These observational data highlight the need for standardized BTX protocols and prospective trials to define patient selection and to balance potential short-term mechanical benefits against complication risks.