Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs

Area of Science:

• Surgery
• Abdominal Wall Reconstruction
• Hernia Repair

Background:

• A lack of standardized classification for incisional hernia repair hinders outcome comparison and risk stratification.
• The Ventral Hernia Working Group (VHWG) grading scale was developed to address this issue.
• This study assesses the VHWG scale's efficacy in predicting surgical site occurrences (SSOs) post-open ventral hernia repair.

Purpose of the Study:

• To evaluate the accuracy of the VHWG grading scale in predicting SSOs.
• To identify factors influencing SSO incidence in open ventral hernia repair.
• To propose modifications to the VHWG scale for improved predictive accuracy.

Main Methods:

• A prospective database of open ventral hernia repairs was analyzed.
• Hernias were graded using the VHWG scale.
• Patient comorbidities, hernia characteristics, and CDC wound classification were correlated with SSO incidence.

Main Results:

• Surgical site occurrence rates increased with VHWG grade (14% grade 1 to 49% grade 4).
• Certain grade 3 classifications (e.g., previous wound infection) showed SSO rates similar to grade 2, while GI tract violations resembled grade 4.
• CDC wound classification effectively predicted SSO across contamination levels.

Conclusions:

• Modifying the VHWG scale into a 3-level system would enhance SSO prediction accuracy.
• A revised scale should categorize comorbidities and previous wound infections into grade 2.
• Stratifying grade 3 based on CDC wound contamination definitions is recommended for improved outcomes reporting.