Lifestyle-related risk factors and recurrence after ventral hernia surgery: nationwide registry and survey study.

Abstract

Background: The study evaluated the associations of individual and combined lifestyle-related risk factors with long-term recurrence after primary and incisional ventral hernia repair compared with patients without lifestyle-related risk factors.

Methods: This nationwide study used registry and survey data from Danish patients who underwent ventral hernia repair between 2014 and 2024. Patients were identified in the Danish National Patient Register, after which digital surveys were distributed. Survey data on recurrence and lifestyle factors were linked with data from the Danish Ventral Hernia Database and Danish National Patient Register. The outcome was hernia recurrence (reoperation or self-reported). Average treatment effects were estimated using adjusted logistic regression and standardization (G-computation).

Results: In total, 18 959 patients were included in the study, comprising 15 186 patients undergoing primary ventral repair and 3773 undergoing incisional hernia repair (response rate 78%). More than half the patients reported one or more lifestyle-related risk factors. For primary ventral hernia repair, the adjusted population-averaged recurrence prevalence was 14% without lifestyle-related risk factors. Smoking, obesity, and their combination were associated with a higher recurrence prevalence, with absolute differences of 3% (95% confidence interval (c.i.) 0% to 5%), 3% (95% c.i. 2% to 5%), and 6% (95% c.i. 2% to 10%), respectively. Other lifestyle combinations showed similar trends but were less consistently significant across analyses. For incisional hernia repair, the adjusted population-averaged recurrence prevalence was 25% without lifestyle-related risk factors. Smoking and obesity were associated with absolute increases in recurrence prevalence of 6% (95% c.i. 0% to 11%) and 5% (95% c.i. 1% to 9%), respectively.

Conclusions: Smoking and obesity were associated with a higher recurrence prevalence after primary ventral and incisional hernia repair. Associations for combined lifestyle factors were less consistent overall. Given the number of analyses performed, the findings should be interpreted with caution.