A. K. Hallway1, R. Howard1, B. Fry1, A. Ehlers1,2, S. O’Neill1, J. Dimick1, D. Telem1 1University Of Michigan, Department Of Surgery, Ann Arbor, MI, USA 2VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
Introduction: The inability to capture and pair long-term operative and nonoperative recurrence with clinically nuanced abdominal wall hernia data remains the Achilles’ heel of hernia research. Linking long-term outcomes with intraoperative data regarding hernia size, location, and repair technique may help inform practice improvement. We deployed a pilot effort to capture long-term clinical recurrence as part of a population-based, clinically nuanced hernia registry.
Methods: We used the Ventral Hernia Recurrence inventory, a validated patient-reported outcome tool, to survey patients in the Michigan Surgical Quality Collaborative Hernia Registry. We studied patients who underwent ventral or incisional hernia repair between January 1, 2020 and December 31, 2020 at 8 pilot hospitals. Surveys were administered between 1-2 years after surgery and asked patients about signs and symptoms of hernia recurrence. We performed multivariable logistic regression modeling to evaluate the independent association of patient and hernia characteristics with reporting symptoms of recurrence or pain. Characteristics included in regression models were age, sex, body mass index, American Society of Anesthesiologists classification, surgical priority (elective vs. non-elective), surgical approach (open vs. minimally invasive), and hernia characteristics (prior repair, hernia location, hernia size, and mesh use).
Results: 144 of 555 patients responded to surveys and had complete data (response rate 25.9%). There were no significant differences in hernia size, location, and repair between responders and non-responders. Among responders, the mean (SD) age was 54.5 (13.9) years, mean hernia width was 3.4 (3.0) cm, and 70 patients (48.6%) were female. Overall, 39 patients (27.1%) answered "yes" to "Do you feel or see a bulge?" and 46 patients (31.9%) answered “yes” to “Do you have physical symptoms or pain at the site?". In multivariable logistic regression models, age was the only factor significantly associated with feeling or seeing a bulge (aOR 0.97 [95% CI 0.94-0.99]) or having physical symptoms or pain at the hernia site (aOR 0.96 [95% CI 0.93-0.99]). The adjusted probability of having symptoms of a recurrent hernia between 1-2 years after surgery was significantly lower among older patients compared to younger patients.
Conclusion: Roughly a third of patients reported symptoms between 1-2 years after ventral and incisional hernia repair, which is far higher than reported rates of long-term operative recurrence. Although comorbidities and hernia characteristics were not associated with long-term symptoms, younger patients were more likely to report symptoms of a recurrent hernia on long-term follow-up.
