title: Incisional hernia repair after caesarean section: a population-based study.
abstract: BACKGROUND
  Incisional hernias occur at surgical abdominal incision sites, but the association with caesarean section (CS) has not been examined.
  
  
  OBJECTIVE
  To determine whether CS is a risk factor for incisional hernia repair.
  
  
  METHODS
  Population-based cohort study in Australia using linked birth and hospital data for women who gave birth from 2000 to 2011. Survival analysis was used to explore the association between CS and subsequent incisional hernia repair. Analyses were adjusted for confounding factors, including other abdominal surgery. The main outcome measure was surgical repair of an incisional hernia.
  
  
  RESULTS
  Of 642,578 women, 217,555 (33.9%) had at least one CS and 1,554 (0.2%) women had a subsequent incisional hernia repair. The rate of incisional hernia repair in women who had ever had a caesarean section was 0.47%, compared to 0.12% in women who never had a caesarean section. After controlling for the duration of follow-up and known explanatory variables (eg other abdominal surgery, parity and multiple pregnancy), the adjusted hazard ratio (aHR) was 2.73 (95% confidence interval (CI) 2.45-3.06, P < 0.001). Incisional hernia repair risk increased with number of caesarean sections: women with two CS had a threefold increased risk of incisional hernia repair, which increased to sixfold after five CS (aHR = 6.29, 95% CI 3.99-9.93, P < 0.001) compared to women with no CS.
  
  
  CONCLUSIONS
  There was a strong association between maternal CS and subsequent incisional hernia repair, which increased as the number of CSs increased, but the absolute risk of incisional hernia repair was low.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia; Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia.
authors.forename: Antonia W
authors.initials: AW
authors.lastname: Shand
authors.forename: Jian Sheng
authors.initials: JS
authors.lastname: Chen
authors.forename: Margaret
authors.initials: M
authors.lastname: Schnitzler
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000706:statistics & numerical data*; D006801:Humans; D012307:Risk Factors; D055815:Young Adult
keywords: caesarean section; incisional hernia; population-based