What potential complication of IAH should be most concerning in a patient who has undergone open repair of ventral hernias?

Intra-abdominal hypertension (IAH) can lead to significant complications following surgical procedures, especially in the context of open repair of ventral hernias. Among the possible concerns, decreased cardiac output is a critical complication because it reflects the body's ability to maintain adequate circulation and oxygen delivery to vital organs.

When IAH occurs, increased pressure within the abdominal cavity can compress major blood vessels, including the inferior vena cava. This compression can impede venous return to the heart, leading to a reduction in cardiac output. As a result, vital organs may not receive sufficient blood flow, which can precipitate multi-organ dysfunction, particularly in already compromised patients.

While other complications such as infection, pneumonia, and abdominal compartment syndrome could be significant in their own right, decreased cardiac output stands out in the context of IAH due to the immediate and systemic consequences it poses for organ perfusion and overall hemodynamics. This includes the potential for severe cardiovascular issues, which can complicate recovery and increase morbidity and mortality postoperatively. Recognizing the risk of decreased cardiac output in the setting of IAH helps prompt timely intervention to manage abdominal pressure and preserve cardiovascular stability.