Younger age is associated with higher recurrence after primary ventral hernia repair: A nationwide register- and survey-based study.

Abstract

Primary ventral hernia repair is common, but the association between age and recurrence remains unclear. We aimed to investigate age differences in the prevalence of recurrence after primary ventral hernia repair. We conducted a Danish nationwide register- and survey-based study including adults aged 20-89 years who underwent repair of primary ventral hernias with a defect width of ≤4 cm between 2014 and 2024. Patient-reported outcomes from the AFTERHERNIA Project survey were linked with data from the Danish Ventral Hernia Database, the Danish National Patient Register, and the Danish Civil Registration System. The primary outcome was overall hernia recurrence, defined as a composite of reoperation for recurrence or self-reported recurrence. Recurrence was assessed across 10-year age groups using logistic regression with marginal standardization to estimate prevalence and prevalence differences. Of 20,321 eligible participants, 16,256 responded (response rate 80%) and were included. Median follow-up was 5.5 years. Prevalence of recurrence decreased with increasing age, and this age-related pattern was consistent across all subgroup analyses. Patients aged 20-29 years had the highest adjusted prevalence of recurrence, affecting more than one third of patients (prevalence 35.6%, 95% CI 31.2-40.2), corresponding to an adjusted prevalence difference of 15.0% (95% CI 10.9-19.1) compared with those aged 50-59 years. In contrast, 90-day readmission after index repair showed no clear age-related pattern. Recurrence after primary ventral hernia repair showed a consistent age-related pattern, with the highest prevalence among younger patients. Age could therefore be considered in preoperative risk counselling.