Abstract
PurposeThe Ventral Hernia Working Group (VHWG) classification of ventral/incisional hernia (IH) was developed by expert consensus in 2010. Subsequently, Kanters et al. have demonstrated the validity of a modified version of the system for predicting short-term outcomes. This study aims to evaluate the modified system for predicting hernia recurrence.MethodsPatients undergoing IH surgery (defined by OPCS codes) in the England Hospital Episode Statistics (HES) database, from 1997 to 2012, were identified. Baseline demographics at index hernia operation and episodes of further hernia surgery (FHS) were recorded. Risk factors for FHS were identified using cox regression and evaluated against the modified-VHWG grade using receiver-operating characteristics (ROC).ResultsThe final analysis included 214,082 index IH operations. Of these, 52.6% were female and mean age was 56.59 (SD15.9). An admission for FHS was found in 8.3% cases (17,714 patients).Multi-variate cox regression revealed contaminated hernia (p < 0.0001), pre-existing IBD (p < 0.0001) and hernia comorbidity (p = 0.05) to be significantly related to long-term FHS. Classifying patients using these factors, according to the modified-VHWG classification, revealed that compared to Grade 1, the hazard ratio (HR) of FHS increased in Grade 2 (HR 1.19; p < 0.0001) and further increased in Grade 3 (HR 1.79; p < 0.0001). ROC analysis revealed the area under the curve to be 0.73 (95% CI 0.73–0.74).ConclusionThis analysis demonstrates the broad validity of the modified-VHWG classification in discriminating risk for FHS. Inclusion of pre-existing IBD as a factor defining Grade 2 patients would be recommended. This analysis is limited by the absence of certain factors within the HES database, such as BMI.
Highlights
Hernia surgery encompasses a wide range of the general surgical workload
This is an average of 7.8 admissions per case, the distribution is skewed towards those with multiple comorbidities and not all admissions were related to the hernia surgery
This study demonstrates the point prevalence of ventral/ incisional hernia surgery has increased over time, as has the point prevalence of contaminated cases
Summary
Hernia surgery encompasses a wide range of the general surgical workload. The incidence of incisional hernia following laparotomy is thought to be approximately 10% [1,2,3,4,5] and 10% of these hernia repairs will recur and will require further surgical repair [6]. Population level studies of incisional hernia surgery are rare. This is likely as a result of the large variation the scope and scale of hernia surgery. A number of attempts have been made to classify ventral hernia defect in order to define complexity and aid comparison between studies [7,8,9]. Many of these were described a number of years ago, none has been taken up across the surgical community or successfully validated across all cases
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