Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients

Abstract

Purpose Data on primary (PH) and incisional hernias (IH) are often pooled, even though several studies have illustrated that these are different entities with worse outcomes for IHs. The aim of this study is to validate previous research comparing PHs and IHs and to examine whether hernia width is an important contributor to the differences between these hernia types. Methods A registry-based, prospective cohort study was performed, utilizing the French Hernia Club database. All patients undergoing PH or IH repair between September 8th 2011 and May 22nd 2019 were included. Baseline, hernia and surgical characteristics, and postoperative outcomes were collected. Outcomes were analyzed per width category (≤ 2 cm, 3–4 cm, 5–10 cm and > 10 cm). Results A total of 9159 patients were included, of whom 4965 (54%) had PH and 4194 (46%) had IH. PHs and IHs differed significantly in 12/15 baseline characteristics, 9/10 hernia and surgical characteristics, and all outcomes. Overall, complications and re-interventions were more common in patients with IH. After correcting for width, the differences between PH and IH were no longer significant, except for medical complications, which were more common after IH repair compared to PH. Conclusion After correcting for hernia width, most outcomes do not significantly differ between PH and IH, indicating that not hernia type, but hernia width is an important factor contributing to the differences between PH and IH.

Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

“…These results reflect the heterogeneity of the two hernia groups (Primary Ventral and Incisional). The result confirms the need for separate analyses for the two types of hernias, and it is consistent with the statements we found in the literature [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…However, the sample size is not sufficient to model the interactions of two influencing variables for both hernia types in the same model and to quantitatively compare them with each other with the help of higher-order interactions. As already described in the introduction, a joint analysis is not recommended in the literature [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ], which we confirm hereby.…”

“…Therefore, procedures for the treatment of both hernia types are regularly performed. As already described above, primary ventral and incisional hernias, as well as their treatment, substantially differ [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ]. Several studies have shown that the outcome and the relevant factors of surgical repair for both primary and incisional hernias should be analyzed separately because of different influencing factors that do not correlate between hernia types [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…After reviewing the existing literature [ 3 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] and following our previous publication [ 18 ], our hypothesis states that primary ventral hernias and incisional hernias must be analyzed separately, and that ventral hernia repair in the SwissDRg system is deficient, but that an increase in yield is possible [ 18 ]. We postulated that individual operations suitable for teaching could be identified.…”

“…The literature reviewed confirms this hypothesis [ 3 , 17 , 18 , 19 , 20 ]. For this purpose, we analyzed primary ventral and incisional hernias separately as described above [ 6 , 11 , 12 , 13 , 14 , 15 , 16 ] based on their contribution margins (in this case CM4) [ 21 ]. In the multi-level contribution calculation (in this case, 4-stages), all costs are deducted from the original operating income gradually (in this case in four steps) so that the contribution margin (in this case CM4) remains at the end [ 21 , 22 , 23 ].…”