Incidence, risk factors, and burden of incisional hernia repair after abdominal surgery in France: a nationwide study

PurposeIncisional hernias are common after laparotomies. The aims of this study were to assess the rate of incisional hernia repair after abdominal surgery, recurrence rate, hospital costs, and risk factors, in France.MethodsThis national, retrospective, longitudinal, observational study was based on the exhaustive hospital discharge database (PMSI). All adult patients (& GE; 18 years old) hospitalised for an abdominal surgical procedure between 01-01-2013 and 31-12-2014 and hospitalised for incisional hernia repair within five years were included. Descriptive analyses and cost analyses from the National Health Insurance (NHI) viewpoint (hospital care for the hernia repair) were performed. To identify risk factors for hernia repair a multivariable Cox model and a machine learning analysis were performed.ResultsIn 2013-2014, 710074 patients underwent abdominal surgery, of which 32633 (4.6%) and 5117 (0.7%) had & GE; 1 and & GE; 2 incisional hernia repair(s) within five years, respectively. Mean hospital costs amounted to euro4153/hernia repair, representing nearly euro67.7 million/year. Some surgical sites exposed patients at high risk of incisional hernia repair: colon and rectum (hazard ratio [HR] 1.2), and other sites on the small bowel and the peritoneum (HR 1.4). Laparotomy procedure and being & GE; 40 years old put patients at high risk of incisional hernia repair even when operated on low-risk sites such as stomach, duodenum, and hepatobiliary.ConclusionThe burden of incisional hernia repair is high and most patients are at risk either due to age & GE; 40 or the surgery site. New approaches to prevent the onset of incisional hernia are warranted.

Automated summary

This study aims to assess the rate of incisional hernia repair, recurrence rate, hospital costs, and risk factors in France. The results show that the burden of incisional hernia repair is high and most patients are at risk, especially those aged 40 or older or with high-risk surgical sites. New approaches are needed to prevent the onset of incisional hernia.