Drivers of variation in outcomes after ventral hernia repair: a contemporary registry analysis of over 73,000 ACHQC cases.

purposeTo determine whether differences in operative approach and outcomes after ventral hernia repair (VHR) are primarily associated with case acuity and hernia complexity rather than surgeon practice grouping.

methodsAdult VHRs recorded in the Abdominal Core Health Quality Collaborative (ACHQC)registry from 2013-2023 were analyzed. Cases were grouped by surgeon practice category (General Surgery [GS], Minimally Invasive Surgery [MIS], and Acute Care/Trauma Surgery [ACS]). Patient characteristics included demographics, ASA class, case urgency, operative approach, mesh width, and operative duration. Outcomes included recurrence at 30 days, 6 months, and 1 year (among patients with available follow-up) and health-related quality of life measured by HerQLes, with moderate-to-major improvement defined as a ≥20-point increase from baseline among patients with paired assessments.

resultsA total of 73,241 VHRs were analyzed (GS 56.2%, MIS 28.1%, ACS 15.6%). Operative approach distribution was similar across groups (open 63.8%, robotic 26.0%,laparoscopic 10.2%; p>0.05). ACS cases more frequently involved very large meshes (≥30 cm) and prolonged operative duration (>240 minutes), reflecting higher case complexity (both p<0.05). Early quality-of-life improvement at 30 days was most pronounced among ACS patients, whereas GS patients demonstrated the highest proportion of sustained moderate-to-major improvement at 6 months. Recurrence was uncommon at 30 days across all groups and increased with longer follow-up, with the highest 1-year recurrence observed among ACS patients.

conclusionsIn this large contemporary registry, operative approach selection was similar across surgeon practice groups. Differences in outcomes were most strongly associated with case urgency and hernia complexity rather than surgeon classification. Early quality-of-life gains were greatest in higher-acuity cases, while more durable improvements and lower long-term recurrence were observed in elective repair contexts. These findings underscore the dominant role of patient and case factors in determining VHR outcomes.