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

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. 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. 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). 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. [Display omitted] •Early complications occurred in 18% of elective ventral hernia repair.•Of patient-specific factors, those focusing on comorbidity burden (e.g. ASA class, frailty score) were associated with complication risk in ventral hernia repair.•A number of hernia-specific and procedural risk factors were associated with complications in ventral hernia repair.