title: Reoperation versus clinical recurrence rate after ventral hernia repair.
abstract: OBJECTIVE
  To compare the clinical recurrence rate with reoperation rate for recurrence after ventral hernia repair.
  
  
  BACKGROUND
  Reoperation is often used as an outcome measure after ventral hernia repair, but it is unknown whether reoperation rate reflects the overall clinical risk for recurrence.
  
  
  METHODS
  The study cohort was recruited from the Danish Ventral Hernia Database and the Danish National Patient Registry during January 1, 2007, to December 31, 2007. Inclusion criteria were primary umbilical/epigastric (umb/epi) or incisional hernia repair from a regional area of 2 million inhabitants. A prospective clinical follow-up was conducted in January 2011 using a validated questionnaire on reoperation and possible recurrence. Suspicion of recurrence was the criterion for clinical examination. A telephone interview and/or patients' hospital files confirmed reoperation.
  
  
  RESULTS
  A total of 945 patients were eligible, and 902 patients responded to the questionnaire (response rate 95%) with a median postoperative follow-up of 41 months (range 0-48 months). The analysis comprised 646 patients with umb/epi and 256 patients with incisional hernia repair. Clinical examination was required in 241 patients. After umb/epi and incisional hernia repair, the cumulative risks of reoperation and overall recurrence (reoperation + clinical) were 4% and 15% (fourfold underestimation), and 8% and 37% (fivefold underestimation) (P < 0.001), respectively.
  
  
  CONCLUSIONS
  Reoperation rate for recurrence 41 months after primary umbilical/epigastric or incisional hernia repair underestimated overall risk of recurrence by four- to fivefolds. This study was registered in www.clinicaltrials.gov (NCT01325246).
authors.affiliation: Danish Hernia Database, Department of surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark. freh@regionsjaelland.dk
authors.forename: Frederik
authors.initials: F
authors.lastname: Helgstrand
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Pernille
authors.initials: P
authors.lastname: Strandfelt
authors.forename: Thue
authors.initials: T
authors.lastname: Bisgaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D055815:Young Adult