Variation in approach for midsize (4-6cm) ventral hernias across a statewide quality improvement collaborative

Abstract

Introduction

Repair of midsize (4–6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.

Methods

Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQCCOHR). MSQCCOHR is the only US population-level registry that captures clinically-nuanced data pertaining to patient hernia characteristics. We included patients who underwent repair of a 4–6 cm hernia from January 1, 2020-June 30, 2022. We stratified repair type as open or minimally invasive and used a multivariable logistic regression model to identify factors associated with MIS approach. Secondary outcomes included complications rate.

Results

Among 771 patients, mean hernia width (SD) was 4.7 cm (0.8) and 339 (44 %) underwent MIS approach. Patients with MIS approach had lower BMI (33.5 vs 34.8, p = 0.02) and less often were ASA class III (47.5% vs 54.6 %, p = 0.02) or ASA class IV (2.4% vs 4.2 %, p = 0.02). MIS approach was associated with smaller mean hernia width (4.71 cm vs 4.84 cm, p = 0.02) and was used more often in the elective setting (94.4% vs 84.0 %, p < 0.01). In the multivariable logistic regression model, higher BMI (aOR 0.97, 95 % CI 0.94–0.99) and urgent/emergent surgery (aOR 0.43, 95 % CI 0.24–0.79) were associated with lower odds of MIS. We found no significant association between MIS and risk of complications (aOR 0.62, 95 % CI 0.37–1.04). Among patients undergoing MIS, more than half (n = 236, 69.6 %) had a robotic approach but there were few patient factors associated with this.

Conclusion

Among patients with midsize hernias, few patient-level factors are associated with approach. This may indicate that surgeon preference factors largely into this decision.