Defect width and operative time are the most significant predictors of venous thromboembolism in ventral hernia repair.

Abstract

Venous thromboembolism is a significant cause of morbidity and mortality among patients undergoing ventral hernia repair. Several risk-assessment models have been developed to predict venous thromboembolism risk for various surgical procedures. However, these models do not include hernia-specific risk factors. Therefore, we sought to evaluate the predictors of venous thromboembolism in patients with a ventral hernia repair in a national hernia-specific database. The Abdominal Core Health Quality Collaborative database was retrospectively queried for ventral hernia repair data. The ventral hernia repair procedures were divided into 2 groups on the basis of whether the patients developed perioperative venous thromboembolism. Baseline and operative characteristics and perioperative outcomes were compared between the 2 groups. The logistic regression was used to assess the association between different risk factors and venous thromboembolism. A total of 43,558 patients were included in the study. The 30-day venous thromboembolism rate among these patients was 0.62% (n = 269). Venous thromboembolism was associated with greater 30-day readmission (odds ratio, 4.29; 95% confidence interval, 3.20-5.76), reoperation (odds ratio, 3.97, 95% confidence interval, 2.63-6.00), and mortality rates (odds ratio, 5.95, 95% confidence interval, 2.62-13.48), all P < .001. Bivariate analysis identified a statistically significant association between several patient characteristics, operation, and hernia- related details; however, multivariate analysis revealed that that only hernia width (each increasing centimeter: odds ratio, 1.07, 95% CI, 1.05-1.09) and operative time compared with 0-59 minutes (60-119 minutes: odds ratio, 4.23; 95% confidence interval, 1.86-9.62; 120-179 minutes: odds ratio, 5.78; 95% confidence interval, 2.57-13.0; 180-239 minutes: odds ratio, 8.01; 95% confidence interval, 3.54-18.10; and 240+ minutes: odds ratio, 17.4; 95% confidence interval, 7.88-38.37) were significantly associated with venous thromboembolism risk. Venous thromboembolism is an uncommon complication of ventral hernia repair. It is associated with increased readmission, reoperation, and mortality rates. Larger defect width and operative time are most predictive of perioperative venous thromboembolism risk for patients undergoing ventral hernia repair.