Prognostic nutritional index (PNI) is a predictor of adverse outcomes following open ventral hernia repair.

INTRODUCTION: Optimization of modifiable risk factors prior to elective ventral hernia repair (VHR) improves outcomes. There is no well-established correlation between nutritional status and outcomes after VHR. Prognostic nutritional index (PNI) is a measure of immune and nutritional status, incorporating albumin and total lymphocyte count. We aim to evaluate the association between PNI and clinical outcomes after open VHR. METHODS: We retrospectively reviewed adult patients who underwent open elective VHR (> 3 cm) between 2023 and 2025 with recent (< 1 month preop) albumin and lymphocyte count, categorized as low PNI (< 45) or normal PNI (≥ 45). Statistical analyses included standard univariate and multivariate logistic regression. RESULTS: 125 patients were included; 42 (33.6%) with low and 83 (66.4%) with normal PNI. 62.4% were male, 75.2% ASA III-IV, 32.8% diabetic, with 32% recurrent hernia on presentation and average defect size of 85.53 ± 98.82cm2; these were similar between groups (p > 0.05). Patients with low PNI were older (64.17 ± 9.83 vs. 58.69 ± 11.15, p = 0.012). Low PNI was associated with fewer clean procedures (CDC Class I 69.0% vs. 81.6%, p = 0.026). Low PNI was associated with increased LOS (5.17 + 7.57 vs. 2.36 + 3.45 days, p = 0.024) and discharge disposition to other than home (9.6% vs. 0%, p = 0.046). There were no differences in ICU stay (16.7% vs. 6.0%, p = 0.103), 30-day reoperation (0.12 ± 0.55% vs. 0.06 ± 0.24, p = 0.829), readmission (0.14 ± 0.35 vs. 0.14 ± 0.35, p = 0.983), or mortality (2.4% vs. 0%, p = 0.336). On multivariate regression, increasing PNI was independently associated with reduction in 30-day surgical site infection (OR 0.788 [0.659-0.942], p = 0.009), without association to major complication (OR 0.969 [0.912-1.028], p = 0.2975), wound complication (OR 0.956 [0.894-1.023], p = 0.1916) or hernia recurrence (OR 1.074 [0.985-1.172], p = 0.1064) at mean follow up of 18.7 ± 23.6 weeks. CONCLUSION: PNI is an independent predictor of surgical site infection after open VHR, and results in longer LOS and higher utilization of rehabilitation services post-discharge. This data may help inform preoperative discussions and risk-stratification. Further studies are warranted to determine whether immunomodulating supplements before elective VHR may improve these measures in patients with low PNI.