Prognostic nutritional index (PNI) is a predictor of adverse outcomes following open ventral hernia repair

Optimization of modifiable risk factors prior to elective ventral hernia repair (VHR) improves outcomes. There is no well-established correlation between nutritional status and outcomes after VHR. Prognostic nutritional index (PNI) is a measure of immune and nutritional status, incorporating albumin and total lymphocyte count. We aim to evaluate the association between PNI and clinical outcomes after open VHR.

We retrospectively reviewed adult patients who underwent open elective VHR (> 3 cm) between 2023 and 2025 with recent (< 1 month preop) albumin and lymphocyte count, categorized as low PNI (< 45) or normal PNI (≥ 45). Statistical analyses included standard univariate and multivariate logistic regression.

125 patients were included; 42 (33.6%) with low and 83 (66.4%) with normal PNI. 62.4% were male, 75.2% ASA III-IV, 32.8% diabetic, with 32% recurrent hernia on presentation and average defect size of 85.53 ± 98.82cm²; these were similar between groups (p > 0.05). Patients with low PNI were older (64.17 ± 9.83 vs. 58.69 ± 11.15, p = 0.012). Low PNI was associated with fewer clean procedures (CDC Class I 69.0% vs. 81.6%, p = 0.026). Low PNI was associated with increased LOS (5.17 + 7.57 vs. 2.36 + 3.45 days, p = 0.024) and discharge disposition to other than home (9.6% vs. 0%, p = 0.046). There were no differences in ICU stay (16.7% vs. 6.0%, p = 0.103), 30-day reoperation (0.12 ± 0.55% vs. 0.06 ± 0.24, p = 0.829), readmission (0.14 ± 0.35 vs. 0.14 ± 0.35, p = 0.983), or mortality (2.4% vs. 0%, p = 0.336). On multivariate regression, increasing PNI was independently associated with reduction in 30-day surgical site infection (OR 0.788 [0.659-0.942], p = 0.009), without association to major complication (OR 0.969 [0.912-1.028], p = 0.2975), wound complication (OR 0.956 [0.894-1.023], p = 0.1916) or hernia recurrence (OR 1.074 [0.985-1.172], p = 0.1064) at mean follow up of 18.7 ± 23.6 weeks.

PNI is an independent predictor of surgical site infection after open VHR, and results in longer LOS and higher utilization of rehabilitation services post-discharge. This data may help inform preoperative discussions and risk-stratification. Further studies are warranted to determine whether immunomodulating supplements before elective VHR may improve these measures in patients with low PNI.