Smoking, obesity and reoperation after elective open mesh repair of umbilical hernia: nationwide cohort study.

Abstract

Introduction: Evidence of the effects of obesity and smoking on complication-related reintervention after elective umbilical hernia mesh repair is limited. This study evaluated the association between these factors and reoperation after mesh repair.

Methods: A nationwide cohort of elective open umbilical hernia repairs from 2017 to 2020 was identified from prospective registration in the Danish Hernia Database. Patients were followed until 31 December 2023 through nationwide registries and complete scrutiny of operative notes associated with succeeding reinterventions. Study outcomes were reoperation for any complication, recurrence, or non-recurrence complication with special reference to the repair method. Multivariable analyses included cause-specific hazard models with adjustment for body mass index (BMI), smoking status, sex, age, and hernia size.

Results: Of the 2391 patients included in the study, 18.4% were smokers and 34.0% were obese (BMI > 30 kg/m2). The follow-up rate was 99.9% over a median of 4.65 years. Reoperation for any complication was increased in smokers compared with non-smokers (hazard ratio (HR) 1.68; 95% confidence interval (c.i.) 1.05 to 2.69; P = 0.032). Reoperation for non-recurrence complications was more frequent in smokers (HR 2.01; 95% c.i. 1.19 to 3.38; P = 0.009) and obese patients (HR 1.83; 95% c.i. 1.12 to 3.00; P = 0.016). Comparable risks of reoperation for hernia recurrence were found between smokers and non-smokers (HR 0.80; 95% c.i. 0.23 to 2.73; P = 0.721) and between patients with and without obesity (HR 0.73; 95% c.i. 0.26 to 2.09; P = 0.559).

Conclusion: Reoperation for any complication after open umbilical hernia mesh repair was more frequent in smokers, whereas no independent association was observed between patients with and without obesity. Smoking and obesity were associated with an increased risk of reoperation for non-recurrence complications, while not affecting reoperation for hernia recurrence.