CT-derived muscle quality predicts recurrence following ventral incisional hernia repair

Incisional hernia repair is challenging because of its high recurrence rate. However, the impact of sarcopenia on the outcomes of incisional hernia remains controversial. This study aimed to investigate the clinical effects of computed tomography (CT)-derived muscle quality in patients who underwent incisional hernia repair.

Clinical data and images of patients who underwent ventral incisional hernia repair between 2016 and 2018 at a university-based tertiary referral center were retrospectively collected. Muscle quality was assessed via CT using the hounsfield unit average calculation (HUAC), total psoas index (TPI), and indexed psoas muscle area (PMAi). The primary outcome was the association between hernia recurrence and CT-derived muscle quality, while the secondary outcome compared the different muscle quality assessment methods in detecting incisional hernia recurrence.

A total of 105 patients were included, with a recurrence rate of 30.5% (32/105). Adjusting for diabetes mellitus, surgery method, mesh position, hernia width, and all three methods for determined muscle quality, Multivariate analysis identified HUAC L3 without contrast (cutoff ≤ 20.1) as an independent predictor of recurrence (p = 0.035). Kaplan-Meier analysis revealed significantly different recurrence-free survival based on the HUAC cutoff (p = 0.017), whereas TPI and PMAi showed no significant association with incisional hernia recurrence (p > 0.05).

CT-derived muscle quality (HUAC ≤ 20.1 on non-contrast CT at the L3 level) was potentially associated with incisional hernia recurrence. HUAC was superior to TPI and PMAi as a surrogate for muscle quality.