What Factors Influence Ventral and Inguinal Hernia Repair Outcomes?

Albert B. Lowenfels, MD


August 10, 2017

Aquina and colleagues' study, appearing in Surgery,[1] investigated the reasons for recurrence of ventral hernia (VHR) and inguinal hernia (IHR), to determine the relative importance of patient, hospital , and surgical factors. The authors used available data from the New York State hospital discharge registry to track outcomes involving 78,267 VHR patients, 124,416 IHR patients, and more than 1500 surgeons.

The main outcome was recurrence rate within a 5-year period. The study confirmed the increased recurrence rates associated with such well-known patient factors as smoking, obesity, and preexisting disease and the protective role of mesh insertion. Hospital factors were less significant than patient factors. After controlling for patient factors, there was marked variation in recurrence rates for both VHR and IHR hernias, with most of the variation attributable to surgical factors.


Surgical repair of hernias is one of the most common operations performed by general surgeons. In the United States, surgeons perform about 360,000 VHR and 800,000 IHR repairs annually. However, almost half of ventral hernias and 10%-15% of inguinal hernias recur. This report, based on a large number of patients, attempts to pinpoint the reason for recurrence.

Patient factors are one explanation, but after controlling for patient factors, surgical factors persisted as the major explanation for differences in hernia recurrence rates. But what are these surgeon-specific factors? Surgical volume and mesh placement explained only a small proportion of the variation in surgical recurrence rate. Unfortunately, hernia size was not included in the available data and could be a major factor in explaining differences in recurrence. The report succeeds in stressing the central role of the surgeon in preventing hernia recurrence, but it also points out the need for discovering currently unknown reasons to explain variation in hernia recurrence rates attributable to surgeons.

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