Textbook Outcomes for Incisional Hernia: W3 EVEREG Database Analysis

The "textbook outcomes" (TO) is defined as a composite indicator that signifies the ideal postoperative course after surgical intervention. To date, TO in hernias has not been studied deeply. This study aims to determine TO in W3 incisional hernia repair using data from the Spanish national EVEREG registry and analyze the variables associated with achieving TO.

A retrospective observational study of W3 incisional hernia repair from the EVEREG registry was performed between January 2012 and December 2022. TO for W3 incisional hernia was defined as: hospital stay less than 8 days, no major postoperative complications (Clavien-Dindo grade IIIa or higher), and no mortality or readmission within 30 days of surgery. Characteristics between TO group and vs non-TO group were compared using both univariable and multivariable logistic regressions.

A total of 2,763 patients were included in the study. TO was achieved in 2,099 patients (75.97%); a prolonged hospital stay was the main factor related to nonachievement. There were multiple variables statistically associated with TO achievement. Also, eventration through an umbilical trocar, clean surgery, laparoscopic approach, the use of nonbiological mesh, elective surgery, or high-risk patient parameters were identified as statistically significant predictors of TO achievement.

We propose novel TO criteria for W3 incisional hernia repair. In this database, the rate of TO was 76%. TO is a composite measure that can be used to carry out healthcare quality improvement programs and compare results between hospitals.