Impact of Obesity on Surgical Approach and Outcomes in Inguinal Herniorrhaphy: An ACS-NSQIP Analysis

IntroductionObesity is a well-established risk factor for the development, recurrence, and postoperative complications of ventral hernia repair. However, the relationship between obesity and inguinal hernia repair is less well defined, with limited evidence on how body mass index (BMI) influences operative approach and outcomes.MethodsA retrospective review of the 2022-2023 ACS-NSQIP database was performed including all adult patients who underwent inguinal and femoral hernia repairs identified using CPT codes. Bivariate and multivariable regression analyses were used to examine the impact of obesity and BMI on operative approach, case acuity, operative time, and short-term outcomes after inguinal hernia repair.ResultsA total of 73 456 adult patients were identified with a mean age of 61 years. Higher BMI was associated with greater operative complexity, including longer operative times and increased use of robotic and combined approaches. Surgical site occurrences (SSOs) were uncommon overall (0.7%) but increased progressively with higher BMI. In multivariable analysis, the association between BMI and operative characteristics, SSOs, and major complications varied across BMI levels. Higher BMI was independently associated with increased odds of SSOs and major complications, while laparoscopic and robotic approaches were consistently associated with lower odds of adverse outcomes compared with open or combined approaches.ConclusionHigher BMI is associated with increased operative complexity and worse short-term postoperative outcomes following inguinal hernia repair, while minimally invasive approaches were associated with lower odds of obesity-related adverse outcomes. These findings highlight the importance of individualized risk stratification and preoperative optimization in inguinal hernia repairs.