Risk factors for incisional hernia repair after aortic reconstructive surgery in a nationwide study

Abdominal aortic aneurysm disease has been hypothesized as associated with the development of abdominal wall hernia. We evaluated the risk factors for incisional hernia repair after open elective aortic reconstructive surgery for aortoiliac occlusive disease and abdominal aortic aneurysm.

A retrospective analysis of prospectively recorded data in nationwide databases was carried out, with merged data from the Danish Vascular Registry (January 2006-January 2012), the Danish Ventral Hernia Database (January 2007-January 2012), and the Danish National Patient Register (January 2007-January 2012) to obtain 100% follow-up for incisional hernia repair in patients undergoing open elective aortic reconstructive surgery. The predefined risk factors of age, sex, American Association of Anesthesiologists score, body mass index, smoking status, type of aortic surgery, and type of incision were tested in a multivariate Cox regression model for the risk of incisional hernia repair.

We identified 2597 patients, of whom 838 and 1759 underwent open elective surgery for an aortoiliac occlusive disease and abdominal aortic aneurysm, respectively. The median follow-up was 28.9 months (range, 0-71.6 months), and the cumulative risk of hernia repair after aortic reconstructive surgery was 10.4% after 6 years of follow-up. Body mass index >25.0 kg/m(2) (adjusted hazard ratio, 1.74; 95% confidence interval, 1.21-2.46) and abdominal aortic aneurysm repair (adjusted hazard ratio, 1.58; 95% confidence interval, 1.06-2.35) were significantly associated with incisional hernia repair.

High body mass index and abdominal aortic aneurysm repair were independent risk factors for a subsequent incisional hernia surgery in patients undergoing aortic reconstructive surgery.