The association of hernia-specific and procedural risk factors with early complications in ventral hernia repair: ACHQC analysis

Mazen R Al-Mansour; Delaney D Ding; Celeste G Yergin; Robert Tamer; Li-Ching Huang

doi:10.1016/j.amjsurg.2024.02.028

The association of hernia-specific and procedural risk factors with early complications in ventral hernia repair: ACHQC analysis

Am J Surg. 2024 Mar 8:S0002-9610(24)00124-7. doi: 10.1016/j.amjsurg.2024.02.028. Online ahead of print.

Authors

Mazen R Al-Mansour¹, Delaney D Ding², Celeste G Yergin², Robert Tamer³, Li-Ching Huang⁴

Affiliations

¹ University of Florida College of Medicine, Gainesville, FL, USA. Electronic address: mazen.al-mansour@surgery.ufl.edu.
² University of Florida College of Medicine, Gainesville, FL, USA.
³ Center for Surgical Health Assessment, Research and Policy, The Ohio State University, Columbus, OH, USA.
⁴ Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 38494357
DOI: 10.1016/j.amjsurg.2024.02.028

Abstract

Background: Many surgical risk assessment tools emphasize patient-specific risk factors. Our objective was to use a hernia-specific database to assess risk factors of complications in ventral hernia repair (VHR) focusing on hernia-specific and procedural factors.

Methods: The ACHQC database was queried for elective VHR in adults from 2012 to 2023. Primary outcome was overall 30-day complications. Multivariable logistic regression was used for analysis.

Results: 41,526 VHR were included. The rate of 30-day complications was 18%, surgical site infection 3%, surgical site occurrence requiring procedural intervention 4%, readmission 4%, reoperation 2%, and mortality 0.2%. Multivariable analysis demonstrated that BMI, ASA, frailty, COPD, anticoagulants, defect width, incisional and recurrent hernias, presence of stoma or prior mesh, prior abdominal wall infection, non-clean wound, operative time, open approach and myofascial release were associated with 30-day complications (OR = 1.01-1.66). Preoperative chlorhexidine, bowel preparation and fascial closure were associated with lower complication risk (OR = 0.70-0.89).

Conclusion: Hernia and procedural risk factors are associated with early complications following elective VHR. These factors need to be included in surgical risk assessment tools, to supplement patient-specific factors.

Keywords: Complications; Outcomes; Risk assessment; Risk factors; Ventral hernia.