ArticleHernia : the journal of hernias and abdominal wall surgery2026
External validation of the Penn hernia risk calculator: an evaluation of model transportability for incisional hernia prediction in open pancreatic surgery.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeIncisional hernia (IH) is the most common long-term complication following open pancreatic surgery. This study aimed to evaluate the transportability of the Penn Hernia Risk Calculator (PHRC) Hepato-Pancreato-Biliary (HPB) model in a geo-temporally diverse population.
methodsAdult patients undergoing non-palliative pancreatic surgery via a transverse laparotomy from April 2012 to December 2023 at a single tertiary academic center were included. Patients with prior IH diagnosis and/or repair were excluded. Demographics, medical history, lab, and operative data were collected. Composite IH risk scores were calculated using the PHRC. Model performance was assessed using the Area Under the Receiver Operating Characteristic Curve (AUROC) and positive likelihood ratios (LR+) across risk thresholds.
resultsA total of 403 patients were included with 4.2% developing IH. The study population differed significantly from the PHRC cohort in 19 of 20 predictive variables. The overall AUROC was 0.548, and LR + values were consistently below 1.8 at all risk thresholds. Calibration plots indicated systematic overprediction of IH risk. Subgroup analysis showed improved performance (AUROC = 0.875, LR + = 0.467) among patients with BMI > 30 kg/m². Malignancy was a protective factor, while undergoing left hemipancreatectomy or central pancreatectomy and BMI 20-30 kg/m² were associated with IH development.
conclusionIn this small single-center cohort, the PHRC HPB model demonstrated poor accuracy in predicting early IH following pancreatic surgery through transverse laparotomy. Performance improved in obese patients, suggesting case-mix and outcome incidence differences may largely explain the lack of model transportability.
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