title: Effect of hernia size on operative repair and post-operative outcomes after open ventral hernia repair.
abstract: BACKGROUND
  Ventral hernia repair (VHR) is a commonly performed operation, but analysis of patient outcomes based upon hernia size is lacking. We sought to identify differences in operative repair and post-operative morbidity and mortality after open VHR based on hernia defect size.
  
  
  METHODS
  Patient and operative data were retrospectively reviewed on all patients undergoing open incisional VHR between January 2008 and February 2015 by a single surgeon at the Johns Hopkins Hospital. Patient variables were described by means for continuous variables and percentages for discrete variables, with differences between groups calculated by Chi-squared analysis.
  
  
  RESULTS
  During the study period, 228 patients underwent open VHR during which intraoperative defect size was measured. Patients were split into four groups based upon defect size: less than 200 cm2, 200-300 cm2, 301-400 cm2, and over 400 cm2. Patients with large defects were more likely to present with a recurrent hernia (P = 0.007) and trended towards a history of wound infections (P = 0.07). Operative time was significantly longer as defect size increased (P < 0.001). Component separation was most frequently used in patients with defects 200-300 cm2in size (P = 0.001), in whom primary closure was most likely to occur. While mesh was used in almost all patients, the specific location (overlay only, underlay only, or overlay with underlay) depended on hernia size (P < 0.001). Mean length of stay increased with defect size (P < 0.001). Larger defect size was associated with increased 30-day morbidity (P = 0.03) but not readmission (P = 0.53), recurrence (P = 0.99), or mortality (P = 0.99).
  
  
  CONCLUSIONS
  Hernia defect size affects operative time and surgical technique for repair of a ventral hernia. Larger defect size is associated with increased post-operative morbidity and length of stay but not readmission, recurrence, or mortality. Hernia size greater than 400 cm2should not be a limitation to operative repair.
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: K E
authors: KE
authors: Poruk
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: N
authors: N
authors: Farrow
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: F
authors: F
authors: Azar
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: K K
authors: KK
authors: Burce
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: C W
authors: CW
authors: Hicks
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: S C
authors: SC
authors: Azoury
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: P
authors: P
authors: Cornell
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors: C M
authors: CM
authors: Cooney
authors: Department of Surgery, The Johns Hopkins School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA. feckhau2@jhmi.edu.
authors: F E
authors: FE
authors: Eckhauser
mesh_terms: D034861:Abdominal Wall / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001837:Body Weights and Measures; D005260:Female; D006555:Hernia, Ventral / Q000473:pathology* / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D055815:Young Adult
keywords: Defect size; Morbidity; Mortality; Open surgery; Surgical site infection; Surgical site occurrence; Ventral hernia repair