The Lifetime Risk of Incisional Hernia Following Open Abdominal Aortic Aneurysm Repair: A Longitudinal Cohort Study

Incisional hernia (IH) is a known complication of open abdominal aortic aneurysm repair (OAAAR), with reported rates ranging from 5.6% to 69%. Few studies have examined the long-term risk of IH. As OAAAR is often performed in younger patients requiring durable outcomes, understanding lifetime IH risk is important for preoperative counselling. This study aimed to determine the lifetime risk of IH following OAAAR.

A retrospective review of patients who underwent OAAAR at Auckland City Hospital between January 2004 and December 2008 was conducted. Patients who died within 30 days of surgery, who resided outside New Zealand, or who had incomplete medical records were excluded. Multivariable Cox regression analysis was performed to assess the influence of demographic, anthropometric, disease, and treatment factors on IH development.

Two hundred and twenty-six patients were identified, of whom 75.7% were male and 85.0% of European ethnicity. 90.7% of the cohort were deceased at the time of analysis. The median follow-up amongst survivors was 18.2 years. In total, 19% of patients developed an incisional hernia after OAAAR. IH was significantly more likely in patients with BMI ≥ 30 kg/m² (aHR 3.49, 95% CI 1.82-6.69, p < 0.001), and those with a previous midline laparotomy (aHR 2.52, 95% CI 1.09-5.85, p = 0.03).

The rate of IH in our OAAAR patient cohort is lower than that described in other OAAAR patient cohorts with shorter follow-up, but is comparable to general laparotomy cohorts. These findings may assist pre-operative counselling on the long-term risk of IH after OAAAR.